THE  CONSERVATION 
OF  THE  CHILD 

BY 
ARTHUR   H  O  LME S 


Southern  Branch 
of  the 

University  of  California 


Los  Angeles 


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THE   CONSERVATION 
OF  THE  CHILD 

A  MANUAL  OF  CLINICAL  PSYCHOLOGY 
PRESENTING  THE  EXAMINATION  AND 
TREATMENT  OF  BACKWARD  CHILDREN 

BY 

ARTHUR  HOLMES,  Ph.D. 

ASSISTANT     DIRECTOR     OF    THE     PSYCHOLOGICAL     CLINIC;     ASSISTANT    PROFESSOR 
OF   PSYCHOLOGY,    UNIVERSITY   OF   PENNSYLVANIA 


PHILADELPHIA   AND    LONDON 

J.  B.  LIPPINCOTT  COMPANY 


Copyright,  1912 

Bt   J.  B.  LlPPINCOTT   COMPANT 


Published  September.  1912 


Printed  by  J .  B.  Lippincott  Company 
The   Washinuton  Square  Press,   Philn/lclpliia,   U.S.A. 


^  LIB 

H'73 

4 

d 

TO 

MY  MOTHER 

THIS  BOOK  IS  AFFECTIONATELY  DEDICATED 


PREFACE 


The  rapid  growth  of  the  new  clinical  psychology  and 
the  inauguration  of  Psychological  Clinics  in  connection 
with  various  institutions  have  made  the  need  of  a  book 
on  this  subject  peculiarly  felt  by  students  and  workers. 
The  Psychological  Clinic  at  the  University  of  Pennsyl- 
vania was  the  pioneer  in  this  country.  Its  sixteen  years' 
existence,  its  accumulation  of  records  and  the  present 
high  state  of  organization  to  which  it  has  been  brought, 
make  an  account  of  its  history  and  functions  especially 
valuable. 

This  monograph  aims  to  give  a  practical  description  of 
the  inauguration  and  operation  of  a  psychological  clinic. 
Being  practical,  it  does  not  attempt  to  go  deeply  into  the 
abstract  principles  underlying  clinic  methods.  AVhile 
giving  several  systems  of  mental  tests  it  do?s  not,  for 
example,  offer  any  extended  discussion  of  their  psycho- 
logical bases,  nor  does  it  enter  into  an  exhaustive  criti- 
cism of  the  definition  and  classification  of  mental  defec- 
tives, but  contents  itself  with  pointing  out  how  the  more 
common  criteria  have  been  applied  in  practice. 

Nevertheless  the  work  is  a  unit  in  itself.  It  covers  the 
field  of  clinic  operations.  It  offers  a  practical  guide  to 
the  psycho-clinicist,  and  at  the  same  time  extends  its 
discussions  of  retarded  children  far  enough  to  make  it 
valuable  and  interesting  to  the  teacher,  to  the  medical 

3 


4  PREFACE 

man,  or  any  one  else  interested  in  child-welfare.  It  in- 
cludes, therefore,  tests  and  measurements  gathered  from 
dijEferent  sources  and  compacted  into  a  form  readily 
applicable  to  the  diagnosis  of  special  children. 

To  my  own  clinic  experience,  covering  a  number  of 
years,  the  aid  and  advice  of  many  workers  in  cognate 
fields  have  been  added.  To  Dr.  Clara  Harrison  Town, 
Director  of  the  Laboratory  of  Clinical  Psychology, 
Lincoln  State  School  and  Colony  at  Lincoln,  Illinois,  I  am 
especially  indebted  for  the  elaboration  of  the  psycholog- 
ical analysis  in  Chapter  VII;  and  to  Dr.  Frieda  Lippert, 
Psychological  Clinic  Assistant  at  the  University  of 
Pennsylvania,  for  help  with  the  physical  examination 
blank. 

Primarily  for  inspiration  to  this  work  and  constant 

guidance  in  it,  my  greatest  debt  is  due  to  Dr.  Lightner 

Witmer,  with  whom  I  have  been  associated,  and  who 

most  generously  placed  at  my  disposal  the  invaluable 

results  of  his  sixteen  years'  experience.     In  making  this 

acknowledgment,  I  express  but  a  very  small  fraction  of 

my  debt  to  him.    What  science  and  society  at  large  owe 

to  him  as  the  inaugurator  of  this  beneficent  application 

of  psychology  to  the  mental  ills  of  children,  only  the 

coming  years  will  reveal. 

ARTHUR   HOLMES. 

University  of  Pennsylvania,  January,  1912. 


EDITOR'S  PREFACE 


The  people  of  this  nation  have  been  prodigal  of  all 
their  resources.  It  was  evident  long  ago  to  the  thoughtful 
mind  that  the  time  was  speedily  approaching  when  we 
should  both  repent  our  extravagance  and  endeavor  to 
institute  such  change  in  our  procedure  as  to  conserve 
what  we  formerly  wasted.  Whence  arose  in  the  past 
decade  the  nation-wide  movement  for  the  conservation 
of  our  natural  resources.  Economic  stress  led  to  this 
reform.  It  is  well,  even  if  it  is  confessedly  late.  In  our 
greed  to  make  easily  a  large  sum  of  wealth  we  have 
wasted  beyond  recovery  a  much  larger  sum.  Wisdom  is 
becoming  our  heritage,  but  it  has  come  \vith  a  limping  gait. 
The  same  general  truth  applies  to  the  conservation 
of  our  greatest  and  noblest  asset — our  children.  We 
have  given  the  child  whose  native  endowinents  made 
easy  its  education  a  fairly  creditable  training.  Those 
that  did  not  readily  lend  themselves  to  the  system  of 
education  as  it  was  were  cast  aside  as  waste  products  of 
our  civilization.  We  are  now  reaping  the  crop  in  shame. 
Our  land  is  filled  ^^^th  all  sorts  of  institutions,  maintained 
at  enormous  cost,  in  which  is  crowded  our  army  of  mis- 
fits. We  cannot  by  legislative  and  philanthropic  endeavor 
meet  the  rapidly  growing  demand.  We  have  neglected 
the  ounce  of  prevention  and  are  feebly  providing  the 
pound  of  cure. 

To  charge  this  situation  to  the  public  school  is  most 
unfair.    The  conditions  governing  these  could  not  result 

5 


6  EDITOR'S  PREFACE 

in  any  other  issue.  These  conditions  the  school  was  forced 
to  accept.  It  did  not  create  them,  nor  did  it  feel  content 
under  them.  The  people  have  applauded  this  great 
institution  of  democracy,  and  neglected  to  make  it  the 
agency  their  platitudes  would  have  it  to  be. 

With  a  fiscal  provision  that  is  unworthy  a  great  people; 
with  partly  trained,  inexperienced  but  thoroughly  well- 
meaning  teachers;  with  overcrowded  classes;  with  inade- 
quate and  at  times  incompetent  supervision;  with  ignoble 
interference  by  school  directors  whose  business  is  legis- 
lative, but  who  made  it  their  business  to  be  executives 
as  well;  with  equipment  confessedly  poor;  with  buildings 
that  were  a  menace,  not  an  aid,  to  right  education;  with 
the  absence  of  uniformity  even  in  ideals,  due  to  inadequate 
supervision;  and  with  substantially  no  provision  for 
enforced  attendance,  for  the  prevention  of  the  exploita- 
tion of  child-labor,  and  for  professional  medical  care  of 
the  child,  the  marvel  is  that  the  school  has  done  so  well. 
The  saving  influence  in  it  all  has  been,  and  is,  the  unselfish 
and  beneficent  force  of  teachers  who  have  faced  a  critical 
situation  with  great  fortitude,  tact  and  devotion.  They 
have  sensed  the  conditions.  They  have  appealed  for 
remedies.  They  have  gone  vastly  beyond  their  legal 
duties  in  a  heroic  effort  to  reach  the  last  child  and  aid 
him  to  his  best  estate  in  the  Republic. 

The  conservation  of  the  child,  by  all  odds  the  most  vital 
conservation  with  which  we  can  have  to  do,  has  thus 
been  allowed  to  await  the  action  of  some  modern  Pesta- 
lozzi; — some  great-hearted  and  sanely-visioned  teacher 
who  would  turn  to  the  waste  products  of  our  schools  and 
in  the  spirit  of  science  and  humanity  ascertain  their  true 
state  and  formulate  such  guidance  as  to  give  to  these 
their  maximum  value  to  society.    We  are  now  doing  this. 


EDITOR'S  PREFACE  7 

The  Psychological  Clinic  at  the  University  of  Pennsyl- 
vania was  a  pioneer  in  this  cause.  Here  the  latest  and 
best  scientific  researcli  has  been  a])plied  to  the  cliild  whose 
mentality  precluded  its  ability  to  proceed  normally  with 
its  education.  Much  has  already  been  done  of  educa- 
tional moment.  It  is  important  now  to  generahze  this 
work,  and  particularly  to  give  teachers  everywhere  an 
insight  into  these  cases,  that  they  may  be  promptly  and 
properly  cared  for.  Theoretically  there  should  be  no 
waste  product  in  our  schools.  As  tools  of  democracy  the 
schools  should  universalize  their  activities.  Practically, 
for  causes  patent  to  all,  there  will  always  be  subnormal 
children.  They  cannot  be  educated  with  normal  children. 
Both  groups  suffer  by  the  contact.  To  detect  the  sub- 
normal children  and  subject  them  to  scientific  diagnosis 
is  the  first  step  in  their  proper  education.  This  nmch  we 
may  now  confidently  claim  is  possible. 

To  classify  the  subnormals  into  such  groups  as  are 
essential  to  their  right  treatment  is  a  vastly  more  complex 
and  difficult  matter.  We  lack  as  yet  absolute  criteria 
for  such  classification.  Scuence  must  give  us  these  stand- 
ards, and  science  will.  It  is  my  opinion,  after  years  of 
observation,  that  too  many  so-called  scientific  diagnoses 
are  crudity  itself, — that  many  a  child  is  classed  as  sub- 
normal whose  only  limitation  is  an  unfortunate  environ- 
ment. The  temptation  to  find  sensational  data  as  to  the 
number  of  "misfits"  in  the  school  is  too  strong  for  some 
to  resist.  The  apparent  willingness  of  an  impatient  or 
overwTought  teacher  may  also  work  injustice  to  some. 
But  with  due  allowance  for  all  this,  there  remains  a  large 
group  for  whom  special  classes  or  some  other  remedial 
agency  must  be  secured.  The  really  subnormal  child 
appeals  in  compelling  ways  to  one's  sympathy.     More- 


8  EDITOR'S  PREFACE 

over,  the  true  ends  of  our  social  democracy  are  vitally 
concerned  in  securing  to  those  the  most  careful  and  com- 
plete training. 

Many  children  need  a  care  and  culture  vastly  more 
specific  in  character  than  they  now  receive.  The  failure 
to  make  suitable  provision  for  these  results  in  great  loss 
to  them  and  to  society.  They  are  indisputably  entitled 
to  the  best  they  can  receive,  and  society  is  the  loser  as 
well  when  any  unit  of  it  acts  below  his  best.  Moreover, 
the  school  is  by  unreflecting  critics  made  to  appear  a 
failure  when  it  is  notoriously  true  that  the  school  alone 
so  nurses  these  cases  along  as  to  gloss  over  what  would 
be  a  social  disaster  were  the  school  rigidly  to  define  its 
scope  and  technically  fulfill  the  letter  of  its  law. 

Back  of  Dr.  Holmes's  discriminating  study  lies  a  great 
educational  and  social  need.  If  we  are  wise  we  shall  heed 
it  and  turn  seriously  to  the  business  of  caring  for  the  most 
hopeless  unit  in  the  social  order.  We  shall  do  this  all  the 
better  by  giving  heed  to  the  facts  here  presented  and 
by  following  the  scientific  method   here  so  graphically 

portrayed. 

M.  G.  B. 

August  22,  1912. 


CONTENTS 


CHAPTER  I 

PAGE 

Historical  Sketch 15 

The  lot  of  the  idiot  in  ancient  times;  in  the  early  Christian 
period;  in  the  Middle  Ages;  during  the  Renaissance;  in 
modern  times. 

The  impulse  for  the  modern  movement;  Periere,  the  predecessor 
of  Rousseau;  "Emile"  and  the  lines  of  modern  pedagogical 
development;  regular  education  in  the  schools;  Pestalozzi; 
the  Kindergarten;  Froebel;  the  modern  physical  education 
through  Basedow. 

The  physiological  education  of  mental  defectives;  the  wild  boy 
of  Aveyron;  Dr.  Itard,  who  was  actuated  by  an  epistemo- 
logical  motive  but  used  the  physiological  method;  his  work 
continued  by  Seguin  in  France,  Saogert  in  Germany, 
Guggenbiilil  amongst  the  Cretins  in  Switzerland ;  the  expan- 
sion of  the  work;  the  movement  conducted  bj'  medical  men. 

The  psychological  movement;  the  new  physiological  psychology; 
clinical  psychology;  the  Psychological  Clinic  established; 
directed  by  a  psychologist;  individual  study  and  treatment 
of  exceptional  children, 

CHAPTER  II 

Constitution  of  the  Clinic 32 

Material  equipment;  rooms,  apparatus  for  tests,  toys,  instru- 
ments, photographic  apparatus,  records,  blanks,  questions, 
files. 
The  Clinic  workers;  the  psychologist  as  head;  reasons  for  such 
an  arrangement;  the  medical  examiner  and  his  work;  the 
social  worker:  her  qualifications,  equipment  and  duties;  the 
recorder:  her  duties  an  J  qualifications. 

9 


10  CONTENTS 

CHAPTER  III 

The  Function  and  Field  of  the  Psychological  Clinic.  . .     45 

The  popular  notion  of  a  psychological  clinic;  what  it  does  not 
do;  what  it  does  do. 

It  has  a  two-fold  function  divided  into  several  tasks;  for  the 
purpose  of  description,  all  these  are  grouped  about  diag- 
nosis of  mental  cases;  its  scientific  tasks, — collecting  and 
filing  data;  discovering  and  proving  tests  or  mental  measure- 
ments; its  philanthropic  task, — connecting  children  with 
the  best  means  of  treatment  at  clinics,  institutions  and 
homes;  advising  teachers  and  parents,  supervising  training 
and  treatment. 

The  need  for  such  an  institution  found  in  the  large  numbers  of 
both  backward  and  mentally  defective  children;  statistics 
quoted. 

CHAPTER  IV 

Operation  of  the  Clinic 76 

The  child  received;  placed  at  ease  by  the  social  worker;  the 
examiner  and  his  duties. 

'ilie  oral  examination  or  history;  begins  with  questions  of 
present  import;  proceeds  to  the  less  known;  mother  and 
teacher  examined  separately. 

The  physical  examination;  is  extensive,  but  not  intensive;  sepa- 
rate rooms;  woman  for  girls. 

Mental  examination;  observation  of  every  movement  of  child; 
examiner  must  be  alert  to  overcome  stubbornness;  make 
allowances  for  fatigue,  excitement,  novelty;  the  mother 
must  be  included  in  the  examination;  parents  are  nearly 
always  ignorant  or  inefficient;  the  inefficient  are  weak  or 
over-hard;  statements  of  play,  music  and  memory. 

The  child  must  be  then  sent  to  a  medical  clinic,  doctor,  special- 
ist; possibly  returned  for  further  mental  tests;  then  sent 
to  regular  school;  or  special  class. 

CHAPTER  V 

Classification  of  Clinic  Cases 92 

Those  who  come  are  already  partially  classified  into  (a)  mental 
deviates;  (fe)  moral  deviates. 


CONTENTS  11 

Most  of  the  mental  deviates  treated  are  arrested,  backward  or 

retarded  in  their  mental  development;  all  can  be  classified 

as  (a)  curably  backward;  {J>)  incurably  backward. 
The  standards  of  normality;  individual,  social,  pedagogical. 
Some  children  are  temporarily  backward  because  of  removable 

defects;  others  incurably  backward,  and  must  be  classified 

as  aments. 
The  temporarily  backward  are   (a)  immediately  recoverable, 

(6)  rapidly  recoverable,  (r)  slowly  recoverable. 
The  incurably  backward  are  further  subclassified  differently 

by    different    authors;    definitions    of    Seguin,    Tredgold; 

classification  of  Tredgold,  Goddard,  Barr,  Binet. 

CHAPTER  VI 

Method  of  Classifying  Clinic  Cases 133 

Theoretical  method  of  direct  observation  upon  some  cerebral 

defect;  the  cases  of  Helen  Keller  and  Kaspar  Hauser. 
Indirect  methods  of  distinguishing  permanent  from  temporary 
mental  retardation;  oral  questioning  to  discover  factors  in 
personal  and  family  history ;  a  physical  examination  made  to 
discover  the  presence  of  removable  physical  defects  and 
stigmata. 

CHAPTER  VII 

Method  of  Classifying  Clinic  Cases  (Concluded) 179 

The  mental  test  proper;  the  place  and  importance  of  mental 

tests. 
Tests  used  in  the  Clinic  for  meiusuring  general  retardation;  the 
pedagogical,  their  significance,  formulation,  use  and  results; 
tests  for  four  school  grades;  Binet  tests;  their  use  and 
significance;  latest  formulation.  Psycho-phj'sical  analysis; 
two-fold  purpose:  (a)  to  locate  the  causes  of  retardation  in 
some  mental  defect,  (6)  to  determine  the  kind  of  training; 
the  tests  themselves  as  formulated  by  the  Clinic. 

CHAPTER  VIII 

Classification  of  Moral  Deviates 250 

Does  moral  imbecility  exist  without  mental  defect?    An  exami- 
nation of  authorities;  their  testimony  does  not  agree. 


12  CONTENTS 

A  study  of  normal  morality;  Sidgwick's  three  methods  of  ethics; 
reduced  to  two  psychological  types:  (a)  rational,  (b)  in- 
stinctive. 

Possible  varieties  of  moral  imbecility;  many  degrees  of  mora! 
imbecility;  moral  responsibility;  Dr.  Tredgold's  theory. 

Diagnosis  of  moral  imbecility;  no  peculiar  symptom-complex; 
the  nature  and  persistence  of  evil  acts;  the  effect  of  disease; 
the  effect  of  heredity;  the  presence  of  mental  defect;  its 
nature;  its  discovery  by  psycho-analysis. 

CHAPTER  IX 

The  Sociological  Relations  of  the  Clinic 299 

Whence  come  the  children  and  whither  do  they  go? 

Scientific  relations;  with  abnormal  psychology;  Dr.  Witmer'g 
outline  of  clinical  psychology  presented  before  the  American 
Psychological  Association. 

Relation  of  the  Clinic  to  the  Hospital  School;  one  supplements 
the  other;  Hospital  School  as  a  temporary  school  or  place 
of  observation;  a  necessity  under  present  social  conditions. 

Children  come  from  high  and  low  society,  illustrative  cases; 
homes,  cases;  public  and  parochial  schools,  cases;  physicians 
and  medical  clinics,  cases;  charitable  organizations,   cases. 

Cases  according  to  their  disposal  may  be  divided  into  three 
classes:  (a)  those  cured  by  medical  or  surgical  relief,  cases 
described;  (6)  those  relieved  by  medical  or  surgical  treat- 
ment, but  requiring  special  training  to  restore  them  to  their 
normal  places  in  school  and  society,  cases;  (c)  those  found 
to  be  incurably  retarded  and  hence  candidates  for  institu- 
tions for  feeble-minded,  cases. 


ILLUSTRATIONS 

FAOB 

Group  of  atypical  pre-adolescent  children  at  dinner  in  special 

class-room 26 

Usual  type  of  form-board  used  in  clinic  examinations 34 

Modification  of  form-board 35 

No  further  tests  necessary  to  show  child  suffering  from  myopia    66 
Adenoid  case.    Four-months-old  baby  from  which  adenoids  were 

removed 66 

Profile  and  side  view  of  adenoid  case 66 

Typical  adenoid  case 66 

Making  head  measurements  in  a  mental  examination 82 

Child  being  tested  for  individual  capacities 88 

Steadiness  test 90 

Test  of  child's  ability  to  form  picture  of,  or  to  recognize  a  shape 

by  touch SO 

Mentally  retarded  on  account  of  tubercular  inheritance,  malnu- 
trition, and  useless  teeth 116 

Mentally  retarded  on  account  of  malnutrition  and  other  physical 

defects 116 

Mentally  retarded  on  account  of  neglect,  malnutrition,  defective 

eyes,  and  speech  defect 116 

On  the  borderland 116 

High-grade  moron.     Very  deaf 132 

Twelve-year-old  high-grade  imbecile  suffering  from  malnutrition  132 
High-grade  imbecile.    Much  more  capable  than  her  appearance 

indicates 132 

High-grade  imbecile.     Ten  years  old.     Less  capable  than  her 

apperance  indicates 132 

Cast  of  cliild's  jaw  malformed  so  that  front  teeth  do  not  come 

together I54 

V-shaped  upper  jaw  which  so  often  accompanies  adenoid  growths  154 

A  hydrocephalic  imbecile.     Low  grade 168 

Middle-grade  imbecile 168 

Hands  and  webbed  fingers  of  Mongoloid  idiot  boy 172 

Hands  of  imbecile  boy,  typical  in  his  physical  appearance 172 

IS 


14  ILLUSTRATIONS 

Materials  for  Binet  tests  (Fig.  1) 213 

Esthetic  comparison.    U.sed  for  6-year-old  Binet  test  (Fig.  2) .  .  215 

Unfinished  pictures.    Used  for  7-year-old  Binet  test  (Fig.  3) .  .  217 

Testing  color  zones  of  eye  with  perimeter 230 

Child  tested  by  ergograph 230 

Record  made  by  plethysmograph  and  pneumograph  on  roll  of 

smoked  paper 244 

Plethysmograph,  for  recording  fine  variations  in  emotions 246 

Cretin  girl.     Typical  position  of  tongue 294 

Case  of  extreme  moral  delinquency.     Age  10  years 294 

Middle-grade  moron-Mongoloid 294 

High-grade  moron.    Negroid  type  of  profile 294 

Group  of  atypical  adolescent  boys 340 


The  Conservation  of 
The  Child 


J.  3  S'3<S 
I. 

HISTORICAL  SKETCH 

The  Treatment  of  Idiots  among  the  Ancients. — The 

lot  of  the  idiot  has  varied  with  the  tides  of  history.  Among 
the  ancients  feeble-minded  children  were  objects  of  de- 
rision, reproach  and  persecution,  were  without  rights  or 
privileges,  accursed  by  the  gods.  Some  nations,  like  the 
Spartans,  got  rid  of  them  by  exposure  or  violence.  Traces 
of  this  practice  are  found  in  the  laws  of  Lycurgus,  and 
intimations  of  it  exist  in  Cicero's  wTitings.  Until  recently 
the  same  custom  prevailed  among  some  South  Sea  Island- 
ers and  some  North  American  Indians,  though  not 
universally  with  the  latter,  as  the  well-knowai  instance  in 
Cooper's  "Deerslayer"  would  indicate.  Even  in  the 
ancient  times  all  idiots  did  not  share  the  same  fate,  for 
we  read  of  Patua,  the  blind  imbecile  slave  of  Seneca's 
wife;  and  of  Nero,  Commodus,  Elagabalus,  three  wearers 
of  the  imperial  purple. 

Early  Christian  Care  of  Idiots. — The  relentless  cru- 
elty of  the  ancients  changed  to  kindness  among  the  early 
Christians  for  whom  Christ's  ministry  to  the  demon- 
possessed  became  a  divine  example.  Notable  leaders  of 
the  early  Church  like  the  Bishop  of  Myra  (the  St.  Nicholas 
of  to-day),  in  the  reign  of  the  Emperor  Constantine  in 

15 


16       THE  CONSERVATION  OF  THE  CHILD 

the  west  about  300  a.d.,  devoted  themselves  to  the  care 
of  these  imfortimates,  and  Euphrasia,  closely  related  to 
the  royal  household  of  Theodosius,  retired  at  the  age  of 
twelve  to  the  convent  of  Thebiad  for  the  same  purpose. 
Examples  of  the  same  consideration  for  the  mentally 
afflicted  are  found  in  other  religions.  Confucius  and 
Zoroaster  commended  iml^eciles  as  objects  of  mercy,  and 
the  Koran  enjoins  all  true  believers  to  have  charity  for 
the  feeble-minded. 

The  Mediaeval  Attitude. — The  early  Christian  zeal, 
sincere  but  miskilled,  changed  to  the  lighter  and  more 
frivolous  attitude  of  the  mediaeval  period.  Imbeciles 
now  became  the  fools  and  jesters  of  the  royal  courts. 
They  had  the  freedom  of  palaces;  they  wandered  unmo- 
lested over  Europe,  and  were  regarded  by  the  French 
especially  as  "enfants  du  bon  Dieu."  They  were  viewed 
by  most  people  with  superstitious  reverence,  as  those 
who  walked  on  earth  but  had  their  conversation  in  heaven. 
For  this  reason  Tycho  Brahe,  the  great  Scandinavian 
astronomer,  retained  always  in  his  observatory  a  fool 
companion  to  whose  babblings  he  listened  as  to  revela- 
tions from  heaven.  Probably  a  remnant  of  that  super- 
stition still  remains  in  the  word  "cretin,"  from  the  French 
"Chretien"  or  Christian,  which  is  yet  applied  to  a  certain 
class  of  defectives. 

The  Renaissance  Reaction. — Such  friendliness,  how- 
ever, based  only  upon  fancy  and  superstition,  could  not 
be  other  than  fitful  and  uncertain.  In  the  Renaissance 
the  pendulum  swung  back  again  toward  the  ancient  cru- 
elty. Luther  and  Calvin  both  denounced  imbeciles  as 
"filled  with  Satan."  As  a  cure  for  their  condition,  beat- 
ings, scourgings,  and  other  forms  of  inhuman  treatment 
were  resorted  to  in  order  to  drive  out  the  possessing 


HISTORICAL  SKETCH  17 

demon.  Even  to-clay  among  the  ignorant  and  supersti- 
tious in  America  such  behefs  arc  still  current,  and  instances 
of  savage  cruelty  practised  upon  the  weak-minded  are 
not  unloiomi. 

Modern  Physiological  Education  the  Source  of 
Training  of  Idiots. — Fortunately,  however,  the  founda- 
tions of  the  modern  understanding  of  imbecility  were 
being  laid  in  the  emphasis  upon  physiological  education. 
From  many  workers,  responsible  for  the  begiimings  of  the 
modern  movement,  there  emerges  distinctly  one  leader  in 
Jacob  Rodrigues  Pereire.  Seizing  upon  the  physiological 
studies  of  other  original  investigators,  his  active  sympathy 
and  powers  as  a  linguist  and  philosopher  led  him  to  apply 
the  physiological  method  to  the  education  of  deaf  mutes. 

Whether  the  streams  of  pedagogical  treatment  of  the 
feeble-minded  can  be  traced  back  to  Pereire  or  not,  cer- 
tainly they  can  be  easily  followed  to  the  marvellous 
suggestor  of  so  many  modern  methods,  Jean 

-r.  /  1   1  •    •       1         Rousseau 

Jacques  Rousseau  (1712-1778),  and  his  origmal 
and  impractical  "Emile."  Through  that  book,  Pesta- 
lozzi  was  directly  inspired  in  1767  to  purchase  a  hundred 
acres  of  ground  in  the  countr}^  to  build  his  cottage,  and 
there  to  undertake  the  rearing  of  his  outi  son  like  the  ideal 
"Emile."  Of  his  seven  years'  experience  in  this  attempt 
he  kept  a  note  book  called  "The  Father's  Journal,"  per- 
haps the  first  piece  of  child  psychology  on  record.  When 
his  experiment  with  his  own  son  failed,  he  enlarged  the 
enterprise  in  1775  by  turning  his  farm  into  a  manual 
training  school  where  the  children  of  poor  neighbors  might 
come  to  study  and  pay  their  tuition  by  the  products  of 
their  toil.  While  his  doctrine  was  "reform  by  environ- 
ment," it  practically  amounted  to  education  by  physical 
training.     This  enterprise  gained  for  him  the  professor, 


18      THE  CONSERVATION  OF  THE  CHILD 

ship  in  the  orphan  asylum  in  Stanz  in  1787,  and  later  led 
him  to  found  his  institute  at  Yverdun  in  1805  from  which 
have  emanated  all  modern  methods  and  theories  of  educa- 
tion. It  was  at  the  latter  institute  that  Froebel  spent  his 
time  from  1782  to  1852  and  received  the  impetus  to  that 
gi-eat  work  for  children  originated  and  carried  on  in  the 
kindergarten. 

Directly  traceable  to  the  wonderfully  suggestive  Rous- 
seau comes  another  line  of  pedagogical  development  closely 
allied  to  physiological  training,  and  developing  into  the 
modern  movement  of  physical  education.  In  1774,  Base- 
dow, directly  influenced  by  the  "Emile,"  founded  his 
Other  Lines  of  Philauthroporium  at  Dessau,  which  in  turn  in- 
Deveiopment  gp^j-g^j  Salzmanu  to  begin  a  similar  work  near 
Gotha  in  1784,  where  Gutsmuths  labored  from  1785  to 
his  death.  Father  Jahn  (1778-1852)  first  met  Freizen  at 
Planann's  Pestalozzian  Institute  at  Berlin,  and  together  in 
1811  they  started  a  Turn  Verein  which  later  became  the 
national  system  of  gymnastics  for  Germany.  In  Nachti- 
gall's  Institute  in  Copenhagen  and  through  Nachtigall  to 
Gutsmuths  in  Germany,  the  Swede,  Peter  Henry  Ling 
(1776-1839),  found  the  mainsprings  of  his  career  and  thus 
connected  the  German-Swedish  gymnastical  movement 
with  Rousseau.  All  this  physical  culture  tended  directly 
toward  a  better  undcrstandin'g  of  the  relation  between 
mind  and  body  and  the  effect  of  physical  training  upon 
intellectual  development. 

The  First  Training  of  an  Idiot. — The  stream  of  his- 
torical interest  which  primarily  concerns  us,  however,  is 
that  which  undertook  the  training  of  the  deficient  child. 
Whatever  the  causes  of  this  development  were,  undoubt- 
edly the  most  striking  single  occasion  for  the  first  experi- 
ment in  modem  training  was  the  "wild  boy"  or  "Sauvage 


HISTORICAL  SKETCH  19 

d'Aveyron."    This  boy,  about  eleven  years  old,  wa.s  dis- 
covered in  the  forest  of  Caune,  Department  of  Aveyron, 
where  he  was  wandering  about  gathering  acorns  and  other 
nuts  for  food.     He  was  caught  and  brought  to 
Paris,  where  his  education  was  begun  by  Dr.  Itard,        Boy  of 

Aveyron 

Physician  to  the  School  for  Deaf  Mutes.  He 
took  up  the  work  of  training  this  child  of  nature  in  order 
to  answer  the  philosophical  questions:  Are  ideas  innate  as 
taught  by  the  rationalistic  school  ?  Or  are  they  abstracts 
from  experience  as  taught  by  the  empirical  school?  Be- 
lieving that  he  had  before  him  a  mind  "undebauched  by 
learning,"  he  set  about  to  show  by  his  method  of  educa- 
tion whether  the  ideas  with  which  the  boy  should  become 
equipped  could  be  drawn  out  of  his  "soul  depths"  or  were 
to  be  imprinted  on  the  tabula  rasa  of  his  mind.  Gradually, 
however,  the  teacher  conformed  his  methods  more  to  the 
needs  of  an  idiot  mind  than  to  those  of  a  normal  mind. 
The  results  of  his  work  were  entirely  discouraging  to  him- 
self, but  he  received  from  the  French  Academy,  who  saw 
better  than  he  the  larger  success  of  his  teaching,  words  of 
praise  and  commendation.  Another  French  physician, 
Edward  Seguin,  less  philosophical  and  more  practical  than 
Itard,  saw  clearly  the  significance  of  the  immense  differ- 
ence between  the  mental  states  of  the  wild  boy  at  the  be- 
ginning of  his  training  and  at  the  end.  In  1837  this  man 
founded  a  school  in  Paris  for  the  education  of  idiots,  the 
first  conscious  attempt  in  this  direction  and  the  first  school 
founded  for  the  purpose  in  all  the  world.  So  greatly  did 
Seguin  enlarge  and  improve  his  system  of  education  that 
in  1842  he  was  made  Director  of  the  Institute  at  the 
Bicetre.  In  this  capacity,  on  account  of  disagreement  with 
the  management,  he  remained  but  a  year,  and  then  retired 
to  his  private  school,  where  he  divided  his  time  between 


20       THE  CONSERVATION  OF  THE  CHILD 

teaching  and  wTiting  on  his  favorite  subjects.  Later,  on 
account  of  political  causes,  he  came  to  America,  where  he 
continued  his  interest  in  the  education  of  idiots  and  was 
instrumental  in  establishing  some  of  oar  largest  and  most 
flourishing  institutions  for  the  feeble-minded. 

Guggenbiihl's  Work  with  Cretins. — The  work  in  Paris, 
in  Germany,  and  in  Switzerland  all  reached  their  efflores- 
cence about  the  year  18^2.  The  story  of  Guggenbiihl  and 
his  Alpine  Cretin  Colony  forms  one  of  the  most  fascinating 
and  romantic  in  this  particular  field.  Inspired  with  a 
lofty  purpose  to  help  these  unfortunates  by  seeing  a  poor 
cretin  praying  by  a  roadside  shrine,  he  settled  in  1836  in 
the  Valley  of  Olienthal,  Switzerland,  for  two  years  to  study 
more  closely  their  condition.  After  that  he  accepted  a 
position  in  an  asylum  near  Berne  in  order  that  he  might 
come  in  sympathetic  contact  with  cretins  and  receive  as 
much  scientific  preparation  as  possible  for  his  life  work. 
His  enthusiastic  temperament  moved  him  to  send  a 
stirring  appeal  to  the  Swiss  Association  for  the  Advance- 
ment of  Science  in  a  little  pamphlet  called  "Christianity 
and  Humanity  in  Regard  to  Cretinism  in  Switzerland." 

Out  of  the  interest  aroused  in  this  particular  class  of 

defectives  came  the  plan  of  forming  a  colony  for  their 

training  and  treatment.     In  1842  a  plantation  on  the 

Abendberg  near  Interlaken,  Canton  Berne,  was 

Abendberg  i  /.  i  , 

secured,  4000  feet  above  the  sea,  over  a  pomt 
where  cretinism  flourished  in  the  valley  below,  and  cot- 
tages were  erected  upon  the  southern  slope,  with  a  hospital 
building  in  charge  of  the  Evangelical  Sisters  of  Mercy  or 
Diakonissen.  To  this  sanatorium  were  brought  little  men 
and  women,  dwarfs  in  body  and  mind,  to  see  what  fresh 
air,  clear  sunlight,  and  scenery  of  unsurpassed  grandeur 
would  do  toward  stimulating  their  dormant  faculties, 


HISTORICAL  SKETCH  21 

Their  diet  was  most  simple,  consisting  mainly  of  vege- 
tables, omitting  potatoes,  with  fruits,  milk,  eggs,  white 
bread,  and  but  little  meat. 

Their  mental  treatment  was  unique,  baaed  as  it  was 
upon  physiological  stimulation  by  oft-repeated,  exagger- 
ated, frequently  changing  stimuli.  For  example,  the 
children  were  taken  out  upon  the  mountain  side  to  view 
the  glorious  sunsets  and  sunrises,  the  magnificent  pano- 
rama, the  stress  and  fury  of  the  storms,  the  thunder- 
ing of  cataracts,  and  the  flashes  of  intramontaine 
lightnings. 

Whether  or  not  it  was  due  to  removing  the  children 
from  the  valley  with  its  depressing  effect  of  overshadow- 
ing mountains,  to  the  change  of  drinking  water,  or  to  the 
healthy  out-door  life  and  more  hygienic  diet,  certain  it  is 
that  many  of  them  improved  marvellously  in  a  short  time. 
The  news  spread  all  over  the  world.  Visitors  came  from 
Germany,  England,  and  even  America  to  view  the  modern 
miracle  of  restoring  idiots  to  their  right  minds.  The  tide 
of  enthusiasm  reached  high-water  mark  in  1850  and  be- 
gan to  ebb  almost  immediately  thereafter.  Allegations  of 
abuse  followed,  and  fuially  an  investigation  was  made  by 
the  British  Minister  at  Berne  which  resulted  in  Guggen- 
biihl's  impeachment  as  a  charlatan   and   the 

•    1     1  1      !■  1  1       r  '^^^^  Collapse 

consequent  Avithdrawal  of  support  by  the  Swiss  of  Guggen- 
Society  for  the  Advancement  of  Science.  In 
vain  did  Guggenbiihl  reply  by  tongue  and  pen.  His  argu- 
ments and  entreaties  were  alike  of  no  avail.  His  institution 
was  disbanded  and  he  retired  to  Montreaux,  where  in  1865 
at  the  age  of  forty-seven  he  died  of  a  broken  heart.  Thus 
closed  one  of  the  most  romantic  tragedies  of  educational 
reform  and  at  the  same  time  one  of  the  most  fertile  and 
far-reaching  in  its  effects  upon  the  treatment  and  train- 


22       THE  CONSERVATION  OF  THE  CHILD 

ing  of  imbeciles.  The  permanent  results  of  the  work 
were  to  be  seen  in  the  great  impetus  to  the  study  of  the 
cretin,  to  the  organization  of  sanatoriums  on  the  cottage- 
colony  plan,  and  later  the  establishment  of  schools  for 
training  all  typea  of  feeble-minded  children. 

The  Work  in  Germany. — The  beginnings  in  Germany 
were  directly  inspired  by  the  example  of  Seguin  at  Paris. 
For  Saegert,  in  Berlin,  while  Director  of  the  Asylum  of 
Deaf  Mutes,  formed  a  private  class  for  imbeciles  in  1845. 
This  work  became  the  inspiration  of  Germany,  and  from 
1846  to  1881  there  were  founded  thirty-two  training 
schools  for  idiots.  Dr  Kern  at  Leipsic  opened  a  private 
asylum  in  that  city  which  was  afterward  removed  to 
Mockem,  and  at  the  time  of  his  death  it  sheltered  fifty 
children. 

The  work  at  Mariaberg  in  Wlirtemburg  was  directly 
inspired  by  Guggenblihl  at  Abendberg.  It  partook  some- 
what of  the  romance  but  far  less  of  the  tragedy  of  the 
parent  institution.  It  began  under  the  most  fortuitous 
patronage.  The  King  of  Wiirtemberg  after  a 
trip  to  Abendberg  came  back  filled  with  enthu- 
siasm and  anxious  to  emulate  the  splendid  work  he  had 
seen  there.  At  home  he  found  an  equally  enthusiastic 
supporter  in  Dr.  Rosch.  Just  at  that  time  Pastor  Halden- 
wang,  who  had  cared  for  a  few  cretins  in  his  home  in 
Wildberg  since  1835,  was  sorrowfully  and  reluctantly  giv- 
ing up  his  little  colony  because  of  lack  of  funds.  This 
small  group  formed  the  nucleus  of  the  new  school  at 
Mariaberg. 

The  next  problem  was  to  obtain  a  suitable  building  for 
domiciling  the  new  family.  They  found  it  in  an  old  dis- 
mantled religious  house  built  under  curious  circumstances. 
Years  before,  Count  Hugo's  two  cliildren,  left  to  play  in 


HISTORICAL  SKETCH  23 

the  harvest  field,  were  suddenly  missed.  Count  Hugo  and 
his  retainers  searched  everyAvhere,  but  found  no  clue  to 
the  lost  children.  The  distracted  father,  fearing  that  they 
had  wandered  into  the  forest  where  they  would  be  de- 
voured by  wild  beasts,  or  that  they  would  fall  into  some 
neighboring  stream  and  be  drowned,  vowed  that  if  his 
little  ones  were  restored  to  him  he  would  build  a  chapel 
to  the  Virgin.  A  little  while  afterwards  the  children  were 
discovered  asleep  under  a  haycock;  and  the  father,  true 
to  his  promise,  erected  the  "Convent  Berg  of  Our  Lady." 
It  was  in  this  building  that  the  new  school  at  Mariaberg 
was  begun.  Here,  on  March  6,  with  royal  patronage, 
with  associations  of  childhood  innocence,  paternal  affec- 
tion, and  religious  zeal.  Dr.  Rosch  began  with  thirteen 
children.  Led  by  the  highest  professional  understanding 
this  school  steadily  developed,  and  was  enlarged,  from  its 
first  educational  activity,  by  the  addition  of  a  custodial 
department  in  1860. 

The  First  Schools  for  the  Feeble-minded  in  England. 
— The  work  spread  from  the  Continent  to  England, 
chiefly  through  the  enthusiasm  of  Dr.  William  Twining, 
who  wrote  his  impressions  from  a  visit  in  1843.  To  this 
influence  was  added  that  of  Mr.  Gaskall  and  Dr.  Con- 
nolly, who  wTote  on  the  Bicetre  in  1843.  As  a  result  of 
this  agitation,  in  1846,  the  Misses  White  formed  a  private 
school  at  Bath.  The  popular  movement,  however,  began 
with  Rev.  A.  Reed,  who  visited  Abendberg  in  1847  and  on 
his  return  held  a  great  meeting,  with  the  Lord  Mayor  of 
London  pre;>iding,  and  successfully  enlisted  sympathy  for 
practical  work.  In  1848  the  Park  House,  Highgate,  was 
opened  a^  a  temporary  home  for  twenty-seven  children, 
and  soon  iiad  increased  to  fifty  children,  who  were  removed 
in  1850  to  Essex  Hall,  near  Colchester.    In  1853  the  pres- 


24       THE  CONSERVATION  OF  THE  CHILD 

ent  institution  at  Earlswood  was  founded  and  the  corner- 
stone laid  by  the  Prince  Consort.  The  two  institutions 
together,  Essex  Hall  and  Earlswood,  accommodated  about 
850  children. 

The  American  Movement.^ — The  inspirations  for  insti- 
tutions in  America  fomid  its  source  in  the  Bicetre,  where 
Horace  Mann  and  George  Summer  made  a  visit  in  1842- 
1843  and  wrote  home  concerning  the  work  done  there.  In 
1846  a  bill  was  introduced  into  the  legislature  at  Albany 
providing  for  the  purchase  of  a  tract  of  land  and  for  the 
erection  of  an  idiot-asylum  thereon.  Here,  in  1851,  an 
experimental  school  was  opened  in  order  to  demonstrate 
its  value  to  the  law-makers,  and  in  1854  the  school  was 
made  permanent. 

Massachusetts  was  a  few  days  behind  New  York  in 
securing  legislation  on  the  subject,  but  succeeded  sooner 
in  starting  its  school,  which  was  opened  under  the  direc- 
tion of  Dr.  Howe,  October,  1846.  In  the  same  year  a 
The  First  pHvate  school  was  opened  by  Dr  H  B.  Wilbur, 
Schools  ^^  Barre,  Massachusetts.  Pennsylvania  did  not 
linger  far  behind  these  progressive  cities  in  the  care  of  her 
deficient  children.  In  1852,  Philadelphia,  always  noted 
for  her  broad  and  liberal  philanthropic  spirit,  opened  a 
school  in  one  of  its  suburbs — Germantown — under  Mr. 
J.  B.  Richards.  This  institution  was  later  removed  to 
Elwyn,  Pa.,  where  it  now  continues  with  more  than  a 
thousand  inmates,  as  the  Pennsylvania  Training  School 
for  Feeble-minded  Children,  under  the  direction  of  Dr. 
Martin  W.  Barr,  chief  physician.  Other  States,  folio  wed 
the  leadership  of  these  three  in  founding  schools  for  men- 
tally defectives,  and,  though  the  multiplication  of  institu- 
tions has  been  rapid,  the  increase  in  idiocy  has  been  so 
much  more  rapid  that  many  thousands  of  the  feeble- 


HISTORICAL  SKETCH  25 

minded  still  remain  untaught.  In  1909  the  Commissioner 
of  Education^  reported  twenty-six  State  institutions  caring 
for  17,549  inmates,  10,679  of  them  in  schools  or  kinder- 
garten; and  seventeen  private  schools  with  927  inmates, 
424  of  whom  were  taught  in  school  or  kindergarten. 
Even  with  this  expansion,  however,  idiocy  has  outstripped 
public  provision,  and  a  most  rigorous  campaign  of  educa- 
tion will  be  necessary  to  bring  an  adequate  response  to  the 
demand,  which  is  constantly  becoming  more  urgent. 

Special  Classes  for  the  Feeble-minded  in  the  Public 
Schools. — The  neglect  of  the  State  to  make  adequate 
provision  for  the  feeble-minded  in  segregated  colonics  has 
thrown  some  of  the  burden  of  their  education  upon  the 
public  schools.  In  them  the  mentally  defective  are  still 
taught  in  classes  with  other  exceptional  children.  Dr. 
William  T.  Harris  ^  first  called  attention  to  pedagogical 
"misfits"  in  St.  Louis  as  early  as  1872,  but  the  educational 
world  was  not  yet  ready  to  study  the  condition.  According 
to  the  Bulletin  for  191 P,  a  total  of  99  cities  had  pubhc 
school  classes  for  mentally  defective  pupils,  and  220  had 
classes  for  mentally  backward  children.  Naturally,  under 
the  circumstances,  the  division  of  school  children  into 
mentally  defective  and  backward  classes  cannot  be  made 
with  any  sharpness,  and  the  organization  and  methods  of 
class  instruction  must  be  similar  for  the  two  types. 

"The  idea  of  establishing  day  classes  and  schools  for 
deficient  children  appears,  however,"  says  the  educational 
Bulletin,   "to   have  been   first  introduced   to   American 

'  Report  of  the  Commissioner  of  Education,  June  30,  1909,  vol' 
ii,  p.  1279. 

^  Leonard  P.  Ayres,  The  Relative  Responsibility  of  School  and 
Society  for  the  Average  Child,  Journal  of  Educatimi,  Dec.  21,  1911. 

HTnite<l  States  Hureau  of  Education,  Bulletin  1911,  No.  11. 
Whole  No.  401,  p  12. 


26       THE  CONSERVATION  OF  THE  CHILD 

teachers  by  August  Schenck,  of  Detroit,  in  1878,  in  an 
address  to  the  American  Teachers'  Association.  Dr. 
Andrew  Rickoff,  superintendent  of  schools  for  the  city  of 
First  Special  Cleveland,  acting  on  Schenck's  suggestion,  estab- 
PuWUc^*"  lished  two  classes  in  Cleveland,  limiting  them, 
Sciioois  however,  to  disciplinary  cases.  The  second  class 
was  established  in  Chicago  in  1892.  This  is  still  in  existence 
and  other  special  classes  have  been  added.  New  York 
established  its  first  class  in  1895,  under  the  direction  of 
Miss  Elizabeth  Farrell.  Several  other  classes  have  since 
been  formed,  and  in  1905  adequate  supervision  was  first 
provided  through  the  appointment  of  Miss  Farrell  as  in- 
spector of  ungraded  classes.  In  the  same  year,  or  a  year 
later,  a  school  was  organized  at  Waukegan,  111.,  by  Supt. 
Hall,  designed  for  backward  children  of  all  kinds,  those 
mentally  deficient  as  well  as  those  retarded  through  lack 
of  educational  advantages." 

According  to  the  same  Bulletin,  ''The  first  city  to  plan 
for  a  complete  organization  of  these  classes  directly  under 
the  city  superintendent  was  Providence,  R.  I.,  which 
formed  six  classes  for  truants  and  disciplinary  cases  in  1893, 
and  a  separate  class  for  backward  children  in  1896." 
Springfield,  Mass.,  followed  with  a  special  class  in  1898; 
Boston  in  1899;  Cleveland  in  1905;  and  Portland,  Me.,  in 
1906.  The  first  class  in  Philadelphia  for  the  training  of 
backward  children  was  probably  that  organiz(?d  during 
the  summer  of  1897  at  the  University  of  Pennsylvania  by 
Dr.  Lightner  Witmer.  This  was  followed  in  1899  by  a 
class  under  the  auspices  of  the  Civic  Club  and  the  Public 
Education  Society,  which  was  taken  over  by  the  Board 
of  Education  in  1901.  At  the  present  time  there  are  about 
seventy-five  special  classes  for  exceptional  children  in  the 
various  school  buildings  of  the  city. 


A  fiiou])  of  atypical  ]irc-a(li)lcsccnt  children  at  (liiincr  in  a  .special 
cluss-room. 


HISTORICAL  SKETCH  27 

The  training  of  mentally  defective  children  so  far 
described  owes  its  impetus  and  support  to  pliysiological 
education.  The  early  physiologists  like  Boerhaave,  Mor- 
gagni  and  Haller;  the  philosophers  and  philologists  like 
Bonnet,  Periere  and  Rousseau,  and  the  philosophical  and 
pedagogical  physicians  like  Pinel,  Itard,  Seguin  and  Gug- 
genbiihl;  the  physical  educators  like  Basedow,  Guts- 
muths,  and  Jahn;  the  educators  and  reformers  like  Pes- 
talozzi  and  Froebel;  all  these  contributed  their  share  to  the 
new  education,  some  emphasizing  the  physical  and  some 
the  mental,  but  all  agreeing  that  the  body  and  mind  must 
grow  together  as  parts  of  one  organism  and  not  as  two 
separate  and  distinct  entities. 

Psychology  Applied  to  the  Problem. — Meanwhile  a 
new  movement  was  germinating  in  the  ferment  of  the 
times.  The  "Origin  of  Species"  marked  the  advent  of 
the  genetic  method  of  science.  Evolution  and  not  creation 
explained  the  problems  of  biology.  This  law  could  not  be 
evaded  by  any  living  being,  not  even  by  the  human  soul 
or  mind.  A  new  physiology  was  the  result.  Linked  as  it 
was  to  the  genetic  theory  and  to  the  materialism  of  the 
times,  and  growing  as  it  did  out  of  physiology,  we  are  not 
surprised  to  hoar  the  new  science  called  "physiological- 
psychology."  Into  the  inception  and  early  stages  of  this 
new  study  we  cannot  go  further  than  to  mention  Lotze's 
Medizinische  Psychologie  of  1857,  and  the  monumental 
works  of  Wundt  begun  by  the  establishment  of  his  physio- 
logical-psychological laboratory  at  Leipzig  in  1879. 

The  new  psychology  did  not  long  remain  in  scientific 
isolation  from  real  life.  Of  course,  like  its  forerunner,  the 
"old  psychology,"  it  made  almost  immediate  connections 
with  pedagogy.  The  genetic  point  of  view,  the  essential 
fact  that  mind  develops  as  well  as  body,  brought  forth  a 


28       THE  CONSERVATION  OF  THE  CHILD 

specific  application  for  the  new  science  to  the  study  of 
child  development.  Ontogenetic  or  child  psychology, 
therefore,  has  become  one  of  its  most  important  depart- 
ments; so  large  that  it  in  turn  has  been  broken  up  into 
Child  various  fields  of  investigation.    One  of  the  most 

Psychology  pj-^ctical  of  these  is  the  new  clinical  psychology. 
Unlike  the  educational  psychology  the  essence  of  its  appli- 
cation is  to  study  the  individual  child  and  remedy  his 
mental  aberrations.  These  studies  have  taken  many  forms 
and  developed  along  many  lines. 

The  Psychological  Clinic. — The  Psychological  Clinic 
at  the  University  of  Pennsylvania  was  established  in 
answer  to  a  direct  call  from  the  educational  world.  Its 
roots  go  down  deep  into  historical  causes;  its  relation., 
with  physiology,  physiological  education  and  all  educa- 
tional reforms  are  close  and  continuous,  but  the  immediate 
occasion  which  led  to  the  discovery  of  an  unoccupied  field 
in  psycho-pedagogy  and  to  the  establishment  of  the  first 
psychological  clinic  was  the  inability  of  a  grade  pupil  to 
read  and  spell. 

In  1896  a  supervising  principal  in  a  Philadelphia  gram- 
mar school,  and  at  that  time  also  a  student  in  the  Psycho- 
logical Department  of  the  University  of  Pennsylvania, 
had  under  her  instruction  a  boy  known  to  the  teaching 
The  First  profcssion  as  a  chronic  bad  speller.  Being  a 
^'"'^  student  of  psychology  and  seeing  quite  naturally 

that  the  science  of  the  processes  of  consciousness  was  the 
one  most  closely  related  to  the  case,  this  teacher  turned  to 
Dr.  Lightner  Witmer,  Professor  of  Psychology  at  the 
University  of  Pennsylvania,  who  undertook  to  ascertain 
the  cause  of  this  deficiency  and  the  proper  treatment  for 
its  elimination. 

Briefly,  he  soon  discovered  that  the  boy  saw  double. 


HISTORICAL  SKETCH  29 

Glasses  were  fitted  to  his  eyes  and  special  instruction  was 
begun  which  soon  brought  about  a  marked  improvement 
both  in  the  boy's  reading  and  spelling.  Unfortunately 
his  early  death  from  a  lingering  disease  cut  short  the  pos- 
sibilities of  observation  and  training,  but  since  that  time 
Dr.  Witmer  has'  been  receiving  children  for  all  manner  of 
mental  and  moral  difficulties  and  treating  them  at  his 
Psychological  Clinic. 

He  had  already  had  some  experience  in  this  special 
line.  In  1889,  while  himself  a  student  of  psychology  at 
the  University  and  also  in  charge  of  English  branches  in  a 
college  preparatory  school  in  Philadelphia,  he  had  found 
a  boy  with  a  remarkable  defect  in  ability  to  learn  English. 
The  boy's  composition  was  especially  poor,  hardly  ever 
containing  a  single  sentence  correctly  formed.  In  his 
mind  there  seemed  to  be  no  distinction  between  present 
and  past  tenses  and  the  endings  of  many  words  were 
clipped  off ,  especially  in  singulars  and  plurals,  adverbs  and 
adjectives.  An  attempt  at  special  training  revealed  a 
verbal  deafness  associated  ^\^th  a  defect  in  articulation. 
An  elementary  training  in  articulation  remedied  the  de- 
fects and  showed  itself  in  a  great  improvement  in  all  his 
wTitten  work  so  that  he  succeeded  in  entering  a  college 
department  the  following  year.  However,  his  deficiency 
in  language  was  not  entirely  overcome. 

Such  experience  led  Dr.  Witmer,  as  enrly  as  December, 
1896,  to  present,  in  an  address  delivered  before  The 
American  Psychological  Association,  a  scheme  of  practical 
work  in  psychology  in  the  following  form : 

1.  The  investigation  of  the  phenomena  of  mental  devel- 
opment in  school  children,  as  manifested  more  particularly 
in  mental  and  moral  retardation,  by  means  of  the  statistical 
and  clinical  methods. 


30       THE  CONSERVATION  OF  THE  CHILD 

2.  A  psychological  clinic,  supplemented  by  a  training 
A  Course  in  school  in  the  nature  of  a  hospital  school,  for  the 
Psychology  treatment  of  all  classes  of  children  suffering  from 
retardation  or  physical  defects  interfering  with  school 
progress. 

3.  The  offering  of  practical  work  to  those  engaged  in 
the  professions  of  teaching  and  medicine,  and  to  those 
interested  in  social  work,  in  the  observation  and  training 
of  normal  and  retarded  children. 

4.  The  training  of  students  for  a  new  profession — that 
of  psychological  expert,  who  should  find  his  career  in 
connection  with  the  school  system,  through  the  examina- 
tion and  treatment  of  mentally  and  morally  retarded 
children,  or  in  connection  with  the  practice  of  medicine. 

In  the  summer  of  1897  the  Department  of  Psychology 
in  the  University  of  Pennsylvania  was  able  to  put  the 
larger  part  of  this  plan  into  operation.  A  four  weeks' 
course  was  given  under  the  auspices  of  the  American 
Society  for  the  Extension  of  University  Teaching.  In 
addition  to  lecture  and  laboratory  courses  in  experimental 
and  physiological  psychology,  a  course  was  given  to  dem- 
onstrate various  methods  of  child  psychology,  especially 
the  clinical  method.  The  Psychological  Clinic  was  con- 
ducted daily  where  children  were  presented  suffering  from 
defects  of  the  eye,  the  ear,  deficiency  in  motor  ability,  or 
in  memory  and  attention.  At  the  same  time  the  special 
class  already  referred  to  was  conducted  in  which  a  group 
of  children  were  taught  throughout  the  session  of  the 
Summer  School,  receivmg  pedagogical  treatment  for  the 
cure  of  stammering  and  other  speech  defects,  for  faults  of 
written  language,  such  as  bad  spelling,  and  for  motor 
incoordination. 
'    The  Psychological  Clinic  has  taken  up  into  itself  what 


HISTORICAL  SKETCH  31 

was  good  in  former  educational  movements.  It  recognizes 
and  makes  use  of  physiological  education.  But,  whereas 
the  former  movements  for  the  training  of  mentally  de- 
fective children  were  based  upon  physiology  and  were 
conducted  by  physicians  aided  by  teachers  following  the 
group-methods  of  the  school-room,  the  clinic  emphasizes 
the  application  of  psychology  to  each  individual  case.  A 
mental  analysis  of  each  child  is  made.  His  intellectual 
idiosyncrasies  are  noted.  His  mental  capacities  are  care- 
fully considered.  Just  what  abilities  he  has  and  to  what 
degree  they  may  be  developed  is  determined.  On  this 
basis,  the  proper  pedagogical  approach  to  his  difficulties 
is  studied  and  pedagogical  advice  is  given.  The  methods 
of  diagnosis  and  of  instruction  are  individual  throughout 
and  both  are  under  the  control  and  direction  of  a  psychol- 
ogist. Upon  these  principles  has  been  founded  the  Psy- 
chological Clinic,  which  presents  the  latest  advance  in  the 
development  of  treating  and  training  exceptional  children.* 
Begiiming  as  it  did  in  1896  with  one  boy,  the  Psychological 
Clinic  of  the  University  of  Pennsylvania  has  been  in  con- 
tinuous operation  up  to  the  present,  1912,  and  during  that 
time  has  examined  over  four  thousand  cases.  In  the  fall 
of  1909  it  was  organized  and  placed  upon  a  broader  basis, 
being  open  daily  for  the  free  examination  of  children  from 
every  quarter.  Just  what  it  is,  its  organization,  its  equip- 
ment, purposes,  aims  and  field,  will  be  discussed  in  the 
succeeding  vsections  of  this  ])ook. 

*  For  more  complete  liistory  of  tlie  treatment  of  the  feeble-minded, 
see  Edward  Sequin,  Idiocy,  lSt36;  Mental  Defectives,  Martin  W. 
Barr,  1904;  The  History  of  the  Feeble-minded,  W.  E.  Fernald,  1893. 


II. 

CONSTITUTION  OF  THE  CLINIC 

The  Location. — The  first  essential  of  a  psychological 
clinic  is  a  location.  For  the  smoothest  and  most  effective 
operation  a  suite  of  small  rooms  is  expedient.  The  outer, 
or  reception  room,  should  be  furnished  with  benches  and 
seats  where  applicants  for  examination  may  wait;  com- 
municating with  this,  another  room  equipped  with  various 
kinds  of  apparatus  for  the  examination  of  children;  and  a 
third,  more  private  than  the  other  two,  where  the  children 
may  be  examined  alone,  or  where  parents  may  be  ques- 
tioned without  the  presence  of  the  children.  In  moral  cases 
the  third  room  is  especially  necessary,  for  it  would  be 
extremely  tactless,  inconsiderate  and  destructive  to  the 
remnant  of  morality  in  a  bad  boy  to  let  him  know  that 
his  reputation  for  goodness  was  entirely  blasted  in  the  eye 
of  his  parents  and  of  the  examining  psychologist  who  is 
to  take  the  place  of  friend  and  adviser  for  months  or 
even  years. 

The  second,  or  examination  room,  should  be  easily  and 
quickly  accessible.  If  possible,  the  exit  from  it  to  the 
street  should  be  by  some  other  way  than  through  the 
receiving  room  or  hall,  for  in  these  cases  the  normal  vis- 
itors feel  most  acutely  the  stigma  of  their  relative's  defi- 
ciency. To  save  them  from  embarrassment  as  much  as 
possible,  as  well  as  to  protect  the  afflicted  ones  from 
exciting  contact  with  strange  persons  and  confusing  move- 
ments through  halls  or  series  of  rooms,  all  arrangements 
should  be  simple  and  expeditious. 

Material  Equipment. — For  making  examinations,  the 
naterial  equipment  must,  of  course,  include  various  kinds 

32 


CONSTITUTION  OF  THE  CLINIC  33 

of  instruments.  Thoy  may  be  divided  into  two  classes: 
common  means  for  making  ordinary  tests  and  special 
apparatus  for  elaborate  and  intricate  examinations.  For 
the  first  we  have  a  series  of  spelling  words,  selections  for 
reading,  arithmetic  problems,  and  samples  of  writing 
suited  to  each  grade  of  the  public  schools  and  intended  to 
gauge  the  pedagogical  standing  of  the  child  of  school  age 
or  above.  Incidentally,  such  exercises  reveal  many  other 
characteristics  besides  mere  scholastic  proficiency.  To 
the  keen  observer  the  simplest  reactions  of  a  child  under 
observation  ,  possess  profound  significance.  Obedience, 
temperament,  coordination,  general  intelligence,  fearful- 
ness  or  fearlessness,  modesty,  egotism,  manners,  training, 
nervousness,  will,  and  a  host  of  other  emotional  and  voli- 
tional attributes,  besides  intellectual  capacity,  may  be 
discovered  at  the  very  first  and  most  simple  test.  In  fact, 
the  success  of  an  ordinary  examination  depends  not  so 
much  upon  specialized  apparatus  as  it  does  upon  the  in- 
ventive genius  of  the  investigator  in  the  manipulation  of 
the  simplest  objects  at  his  command,  and  his  tact  in  draw- 
ing out  all  the  powers  of  the  subject.  Curious  instruments 
with  their  polished  steel  or  lacquered  brass  and  mazes  of 
wires  are  sometimes  positively  detrimental.  They  may 
either  inspire  an  abnormal  curiosity  and  fatiguing  inten- 
sity of  interest  in  details  extraneous  to  the  end  in  view,  or, 
on  the  other  hand,  they  may  produce  a  terror  in  the  feeble- 
minded wholly  destructive  of  any  normal  results.  Com- 
mon toys,  therefore,  will  often  surpass  expensive  apparatus 
in  utility. 

For  example,  a  subject  wholly  apathetic  to  incompre- 
hensible devices  for  attracting  attention  may  arouse  him- 
self and  take  immediate  notice  of  a  wooden  elephant  whose 
swinging  trunk  and  tail  are  moved  by  a  pendulum.    Curi- 
s 


34       THE  CONSERVATION  OF  THE  CHILD 

osity  is  followed  by  movements  revealing  coordination; 
the  name  of  the  carved  beast  is  uttered;  inquisitive  fingers 
explore  its  mysteries;  a  peal  of  laughter — full  of  signifi- 
The  Use  of  cancc  fof  the  observer — is  evoked  by  its  antics, 
°^^  and  beforelongtheerstwhileshyanddiffident  child 

is  completely  engrossed  in  the  examination,  utterly  uncon- 
scious of  his  new  surroundings  and  therefore  quite  natural. 
To  accomplish  this  much-desired  object  a  full  complement 
of  toys — miniature  horses,  dogs,  cats,  deer,  birds,  balls, 
marbles,  dolls,  horns,  kindergarten  blocks  and  the  like — 
must  be  included  in  the  clinical  equipment.  All  the  toys 
should  be  brilliantly  colored  and  some  should  squeak, 
rattle,  and  ring,  for  the  first  requisite  in  many  cases  is  to 
arouse  the  sluggish  sensibilities  of  the  child  into  as  much 
activity  as  possible. 

Next  to  these  commoner  things  for  coordination  tests 
comes  the  somewhat  more  technical  peg-board,  with  large 
pegs  and  large  holes  for  the  lower  grades  and  younger 
children,  and  small  pegs  for  higher  grades  and  older  ones. 
The  pegs,  like  the  toys,  ought  to  be  brilliantly  colored. 
Dyed  yarns  and  ribbons  also  have  their  place  and  serve 
excellently  for  testing  color  perceptional  and  visual 
memory-span. 

A  technical,  yet  comparatively  simple  instrument  is 
the  form  board,  a  rectangular  tray  of  wood  an  inch  and  a 
half  thick,  sixteen  inches  wide  and  twenty-two  inches 
long,  having  in  its  upper  surface  ten  more  or  less  variously 
The  Form  shaped  deprcssions  into  which  are  loosely  fitted 
^"^'"'^  wooden    blocks    of    corresponding    shapes, — a 

circle,  a  square,  a  rectangle,  triangle,  star,  diamond,  hex- 
agon, half-circle  and  oval.  The  test  consists  in  placing 
the  blocks  in  their  proper  depressions,  and  the  method, 
accuracy  and  speed  are  all  factors  in  the  ensuing  judgment 


#11^ 


■  '+  T 


J.== 


The  usual  typo  of  form-board,  u.sod  in  clinic  examinations.  It 
is  a  wooden  board  with  ten  dejjressions  and  ten  variously  shaped 
blocks,  one  fitting  each  depression.  The  test  consists  in  having 
the  child  j)lace  each  block  in  its  proper  depression. 


A  modification  of  the  form-board.  The  figures  are  cut  from 
white  or  colored  card-board  ;  two  of  each  shape,  and  the  child  to 
be  tested  must  match  the  figures  by  placing  each  one  upon  its  mate 
upon  the  table.  The  time  for  the  operation  can  be  noted  by  a  watch, 
and  compared  with  the  times  of  other  children.  This  test  will  act 
as  a  measure  of  co-ordination,  of  the  subject's  perception  of  vLsual 
form  ;  if  the  cards  are  colored,  his  ability  to  name  colors,  match 
colors  and  his  visual  memory-span  for  colors. 

This  modification  of  the  form-board  is  much  more  flexible 
than  th(^  usu.al  form.  In  this  instrument  the  places  of  the  various 
figures  can  be  shifted  at  the  will  of  the  operator  and  so  a  new  situa- 
tion (;an  be  presented  to  each  child  or  to  the  same  (^hild  after  he  has 
tried  it  onc(>  or  several  times.  A  number  of  foims  can  bo  eliminated 
and  the  complexity  of  the;  task  can  be  reduced  to  any  ])roportions, 
thus  bringing  it  always  within  the  ability  of  the  child  being  tested. 
The  more  compl(;x  the  ta.sk  is,  the  greater  is  tin;  intelligence*  mani- 
fested. 


CONSTITUTION  OF  THE  CLINIC  35 

of  the  child's  mentaUty.  The  full  significance  of  the  opera- 
tion will  be  discussed  under  the  operation  of  the  clinic. 

The  technical  instruments  include  many  of  the  pieces 
of  apparatus  usually  found  in  psychological  and  medical 
laboratories.  The  audiometer  is  in  constant  demand. 
The  ophthalmoscope  may  be  used  occasionally,  thougii 
Snellen's  charts  will  answer  most  preliminary  purposes. 
The  dynamometer  may  indicate  slight  differences  in  the 
muscular  power  of  right  and  left  hands  and  lead  to  the 
discovery  of  slight  hemiplegia  or  to  the  recollection  on  the 
part  of  the  parent  of  an  almost  forgotten  case  of  "brain 
fever"  or  meningitis.  The  ergograph  reveals  weakened 
muscular  power,  poor  coordination  and  early  fatigue. 
The  telegraph  key,  the  sound,  touch  and  sight  stimuli, 
and  the  chronoscope  all  play  their  part  in  testing  the 
various  reaction-times.  The  esthesiometer,  algometer, 
and  the  most  sensitive  plethysmograph  often  disclose 
curious  aberrations  of  sensibility.  The  sphygmograph 
and  the  blood-pressure  machine  are  especially  valuable  in 
some  curious  mental  disturbances  accompanied  with  cya- 
nosis and  an  accentuated  second  beat  of  the  heart.  For 
purposes  of  record,  a  complete  photographic  outfit  should 
be  always  instantly  available,  with  a  rapid  lens  capable  of 
catching  the  facial  expression,  so  transient  and  yet  some- 
times so  important  in  diagnosis.  A  dark  room  with  all 
paraphernalia  for  developing,  printing  and  enlarging 
should  be  at  hand.  The  negatives  should  be  classified, 
numbered  and  filed  for  ready  access.  They  have  both  a 
practical  and  a  scientific  value. 

Closely  akin  to  photographic  records  are  casts  of  faces, 
hands,  teeth  and  jaws.  They  should  be  made  whenever 
necessary  and  will  contribute  their  quota  to  the  scientific 
value  of  collected  data.    All  the  required  instruments  for 


36       THE  CONSERVATION  OF  THE  CHILD 

anthropometric  measurements  form  a  necessary  part  of 
the  equipment  for  physical  examinations  as  well  as  special 
medical  instruments  like  mirrors,  ear  and  nasal  spectra, 
tongue  depressors  and  stethoscopes,  with  appurtenances 
for  keeping  all  in  the  safest  aseptic  condition. 

The  Clinic  Staff. — More  important  than  the  whole 
material  equipment  is  the  force  of  workers  manning  the 
psychological  clinic.  The  office  of  the  director  and  chief 
A  Psychoio-  examiner  should  be  held  by  a  psychologist. 
gist  as  Head  -yyj^y  ^  psychologist  rather  than  a  pedagogue  or 
a  physician  would  seem  to  follow  quite  naturally,  sug- 
gested as  it  is  by  the  name  of  the  clinic  itself.  It  might  be 
argued,  however,  that  since  the  large  majority  of  cases 
handled  are  intellectually  retarded  solely  through  remedi- 
able physical  causes,  and  even  mentally  deficient  children, 
imbeciles  or  idiots  are  so  through  some  irremediable 
central  or  peripheral  nervous  lesion,  the  diagnosis  and 
treatment  of  all  such  cases  is  best  directed  by  a  medical 
man.  The  contention  might  be  further  urged  upon  the 
ground  that  physiological  psychology  is  based  upon  the 
theory  of  psycho-physical  parallelism,  whose  fundamental 
postulate  assumes  a  physiological  correlate  for  every 
psychological  phenomenon.  Physiological  functions  ap- 
pear then  to  be  primary.  Why  not  treat  them  and  let 
the  psychical  right  themselves  ? 

The  argument  in  this  form  proves  too  much.  It  elimi- 
nates the  psychologist  entirely  from  the  realm  of  science. 
It  leaves  for  him  no  field  worth  while,  and  therefore  it 
falls  to  the  ground.  For  regular  psychology  is  too  old  and 
well  established  to  be  overturned  by  a  logical  argument 
pushed  ad  absurdum. 

If  the  necessity  and  legitimacy  of  pure  psychology  are 
admitted,  the  same  arguments  hold  for  applied  psychology. 


CONSTITUTION  OF  THE  CLINIC  37 

Granting  that  the  causes  for  intellectual  backwardness  are 
anatomical  or  physiological,  tliey  are  nevertheless  mani- 
fested in  mental  or  moral  symptoms  usually  first  discovered 
in  the  school-room;  and  further,  though  the  physical 
causes  of  backwardness  are  removable  by  surgical  means, 
the  recovery  of  lost  ground  is  to  be  accomplished  by  ped- 
agogical methods  whi('h  are  best  directed  by  the  psycho- 
logical expert  and  carried  out  by  the  specially  trained 
teacher  of  atypical  children. 

Added  to  this  is  the  evident  fact  that  most  medical  men 
are  already  overburdened  with  the  variety  and  extent  of 
knowledge  required  for  any  adequate  treatment  of  physical 
ills.  Even  though  knowledge  were  comprehensible  by 
individuals  the  medical  schools  are  far  from  ready  to  in- 
clude complete  courses  in  psychiatry  in  their  curricula. 
The  historical  fact  that  a  pyschologist,  inspired  by  a  school 
teacher,  founded  the  first  psychological  clinic  for  free  ex- 
amination of  children,  argues  strongly  for  the  continuation 
of  the  work  by  the  profession  which  was  equipped  to  dis- 
cover and  meet  the  need. 

To  be  a  psychologist  only  is  not  enough.  Careful  train- 
ing and  long  experience,  added  to  a  fairly  good  natural 
aptitude,  are  necessary  for  the  administration  special 
of  the  office.  A  wrong  diagnosis  is  fraught  with  Traimng 
the  gravest  consequences,  in  waste  of  money  and  time  and 
life.  The  practical  psychologist,  unlike  the  physician,  does 
not  bury  his  mistakes.  They  drag  out  an  existence  burden- 
some to  themselves  and  their  friends.  It  is  a  grave  fallacy 
to  suppose  that  a  teacher,  no  matter  how  long  experienced 
in  pedagogical  discipline,  or  even  a  medical  inspector  or 
regular  practitioner,  is  fitted  without  special  preparation 
for  pronouncing  upon  the  status  of  a  backward  child. 
Teachers  especiall}--  are  prone  to  be  misled  by  superficial 


38       THE  CONSERVATION  OF  THE  CHILD 

appearances,  as  in  the  ease  of  a  recent  test,  when  a  boy 
was  presented  before  a  selected  group  of  very  intelUgent 
teachers  who  questioned  and  tested  him  in  various  ways 
and  pronounced  him  bright  but  in  need  of  pubhc  school 
instruction.  Their  conclusion  was  largely  due  to  his  ease 
in  reading,  his  volubility,  his  quick,  bright  answers  to 
certain  questions,  his  sparkling  eyes  and  flush  of  apparent 
health.  As  a  matter  of  fact,  the  boy  was  a  middle-grade 
imbecile  with  a  tubercular  diathesis. 

The  regular  practitioner  is  hardly  more  expert  in  his 
diagnosis.  Often  he  soothes  the  family  by  saying  that  the 
child  will  grow  out  of  his  stupidity,  or  that  he  is  suffering 
from  pressure  on  the  brain.  In  any  case  he  makes  no 
attempt  at  a  differential  diagnosis,  nor  is  he  ready  to  sug- 
gest any  remedy. 

The  need  of  special  training  is  recognized  more  and  more 
widely.  Charitable  organizations  are  seeking  specialists 
for  examination  of  their  children.  In  at  least  one  large 
city  such  an  examiner  is  attached  to  the  juvenile  court 
and  it  is  his  business  to  pronounce  upon  every  case  of 
suspected  mental  or  moral  abnormality.  Some  insane 
asylums  have  resident  psychologists  associated  with  their 
chief  medical  advisers.  All  this  indicates  the  importance 
of  the  service  rendered  and  the  growing  necessity  for 
special  training  in  the  diagnosis,  treatment  and  training 
of  backward  and  mentally  deficient  children. 

The  Medical  Examiner. — What  has  been  said  of  the 
necessity  of  a  trained  psychologist  must  not  be  construed 
to  mean  the  elimination  of  the  medical  examiner  from  the 
clinic.  The  importance  of  physical  defects  in  mental 
deficiency  demands  the  skill  of  a  medical  examiner  pre- 
liminary even  to  that  of  the  psychologist.  For,  in  every 
case,  the  first  requisite  for  any  adequate  determination  of 


CONSTITUTION  OF  THE  CLINIC  89 

a  child's  montal  condition  is  tiio  removal  of  all  physical 
obstructions  to  sensory  impressions  and  motor  expression. 
For  example,  double  otitis  with  deafness  will  cut  off  a 
world  of  incoming  auditor}''  impressions  and  consequently 
affect  the  sufferer's  vocal  expression  both  by  reducing  the 
number  of  his  ideas  and  by  preventing  the  clear  articula- 
tion of  the  few  Avords  he  uses.  Such  children  are  very 
frequently  classified  by  teachers  as  "dull,"  ''stupid"  or 
"feeble-minded."  A  girl  was  one  day  brought  to  the 
clinic  by  her  mother  because  the  teacher  said  the  child 
was  hopelessly  incapable  of  learning.  A  cursory  examina- 
tion by  the  medical  examiner  revealed  the  fact  that  the 
girl  was  very  hard  of  hearing.  Further  questioning 
elicited  the  information  that  the  teacher  would  explain 
some  problem  only  parts  of  which  were  heard  by  the  child, 
and  when  she  failed  to  perform  the  operation  correctly, 
as  she  inevitably  did,  the  teacher  lost  patience  and  rele- 
gated her  to  the  class  of  feeble-minded.  Defective  vision, 
adenoid  gro\vths,  retarded  and  impacted  dentition,  heart 
lesions,  rickets,  phthisis  and  indigestion  have  all,  at  one 
time  or  another,  been  diagnosed  by  non-medical  persons 
as  "feeble-mindedness." 

A  part,  therefore,  of  a  mental  classification  is  a  prelimi- 
nary physical  examination  made  by  a  medical  attendant 
except  in  the  lower  grades  of  imbecility  where  no  doubt 
can  exist  as  to  the  ultimate  disposal  of  the  case.  In  regular 
clinical  practice,  mere  suspicion  of  physical  defects  is  suf- 
ficient. For  a  complete  diagnosis  of  a  suspected  ailment 
the  patient  should  be  referred  to  a  specialist.  His  opinion 
is  final.  If  he  advises  surgical  relief  or  medical  treatment, 
it  should  be  given  l>efore  proceeding  with  the  mental  ex- 
amination. In  all  the  higher  grades  on  mental  deficiency 
a  diagnosis  cannot  be  established  while  certain  physical 


40       THE  CONSERVATION  OF  THE  CHILD 

defects  are  present  which  may  be  the  cause  of  only  tem- 
porary intellectual  retardation. 

The  Social  Worker,  her  Duties  and  Qualifica- 
tions.— In  addition  to  the  psychologist  and  medical 
examiner  a  social  worker  is  an  almost  indispensable  mem- 
ber of  the  clinic  staff.  From  the  nature  of  the  case,  the 
post  usually  falls  to  a  woman,  first,  because  it  is  nearly 
impossible  to  secure  a  man  for  the  place,  and  secondly 
because  dealings  with  children  and  mothers  in  their  homes 
demand  the  services  of  a  woman.  Her  natural  qualifica- 
tions should  begin  with  a  fair  share  of  sympathy,  generally 
termed  humanity.  In  personality,  she  should  be  agree- 
able, tactful,  persistent,  courteous,  firm  and  withal  deter- 
mined to  arrive  at  some  specific  result.  In  temperament 
she  should  not  be  extreme,  neither  too  practical  and  con- 
crete, nor  too  theoretical  and  abstract.  Mentally,  she 
should  be  able  to  grasp  the  larger  problems  of  statistical 
values  and  the  cumulative  evidence  of  certain  trends  in 
sociological  forces,  and  she  should  never  permit  her  sym- 
pathy for  individuals  to  confuse  or  obscure  the  relation  of 
individuals  to  the  larger  problems  to  be  worked  out. 
Therefore,  she  should  have  a  grasp  of  the  sociological  field, 
its  fundamental  principles,  and  its  primary  causes,  as  well 
as  its  most  efficient  methods  and  practices;  and  added  to 
this  a  lively  interest  in  statistics,  both  in  their  gathering 
and  framing  in  the  most  practical  forms  for  direct  uses. 

Her  training  should  include  both  theory  and  practice. 
The  first  is  to  be  acquired  in  a  thorough  study  of  the 
elementary  methods  of  modern  psychology.  A  laboratory 
training  is  valuable  both  for  the  knowledge  that  it  gives 
and  also  for  the  discipline  in  method  as  well  as  for  the 
proper  evaluation  of  facts  which  lie  at  its  foundation. 
Upon  this  should  be  built  a  most  comprehensive  training 


CONSTITUTION  OF  THE  CLINIC  41 

in  the  field,  first,  of  child  psychology,  and  secondly,  of 
sociology  and  economics. 

Added  to  theory  must  be  a  wide  practical  social  experi- 
ence with  people  and  organizations.  To  meet  and  deal 
with  people  as  individuals  demands  always  Her  Practical 
actual  experience  combined  with  an  innate  tact.  Experience 
To  deal  with  organizations,  and  especially  to  become 
familiar  ^vith  their  methods,  is  a  matter  of  study  and  ex- 
perience which  can  be  acquired.  For  the  best  results  a 
sharp  and  clear  distinction  should  be  made  between 
psychological  clinic  social  worker  and  a  social  worker 
attached  to  a  psychological  clinic.  While  indeed  the 
distinction  is  one  of  verbal  emphasis,  nevertheless  its 
translation  into  practice  results  often  in  an  emphasis  of 
energy,  time  and  thought.  The  social  worker  attached  to 
a  psychological  clinic  in  contradistinction  to  a  psycho- 
logical clinic  worker  tends  to  look  upon  her  work  as  dis- 
tinctly apart  from  psychological  results.  She  will  be 
strongly  disposed  to  measure  the  outcome  of  her  efforts 
in  terms  of  cleanliness,  good  clothes,  improved  environ- 
ment, or  the  disposal  of  the  "case"  in  some  "good" 
institution. 

The  duties  of  the  social  worker  can  be  divided  into 
two  classes:  at  the  clinic  and  outside  the  clinic.  At  the 
clinic,  it  falls  to  her  to  make  arrangements  for  the  recep- 
tion of  the  cases,  to  make  appointments  for  them  at  the 
other  clinics  to  which  they  are  referred  for  further  investi- 
gation, to  see  that  the  various  instruments  are  ready  for 
use,  and  in  all  things  to  assume  the  relation  to  the  examin- 
ing psycliologist  or  m(>dical  man  that  a  trained  nurse  does 
to  the  surgeon  at  a  clinical  operation. 

Outside  of  the  clinic  her  duties  will  carry  her  far  afield, 
for  whatever  the  future  may  bring  forth,  the  present  state 


42       THE  CONSERVATION  OF  THE  CHILD 

of  ignorance  on  the  part  of  parents  demands  that  some  one 
urge  them  to  follow  the  simplest  rules  for  hygiene  or  medi- 
cal treatment.    The  social  worker  is  the  one  who  will  visit 

the  homes  of  the  children,  study  their  social  con- 
Duties  .  .  1         J 

Ou^ide  the  ditions  and  the  bearing  of  these  conditions  on  the 
mental  and  moral  state  of  the  individual;  will 
work  with  the  parents,  persuade,  insist  and  persist  until  the 
proper  treatment  and  training  as  far  as  possible  is  carried 
out.  Oftentimes,  but  purely  secondarily,  and  with  due 
care  not  to  undertake  the  duties  of  charitable  organiza- 
tions already  in  the  field,  it  will  be  necessary  to  procure  and 
distribute  clothing  for  some  children.  However,  at  this 
point  the  psychological  clinic  social  worker  must  guard 
against  the  already  rank  evil  of  multiplication,  reduplica- 
tion and  overlapping  of  charitable  functions.  If  she  holds 
constantly  and  clearly  in  mind  the  fundamental  purpose  of 
a  psychological  clinic,  good  sense  will  enable  her  to  deal 
with  individual  cases  which  no  general  rules  can  ever 
possibly  cover. 

To  illustrate  both  the  value  and  range  of  her  services, 
one  instance  is  here  given.  Case  268,  a  tubercular  boy,  was 
A  Case  referred  to  the  Psychological  Clinic  by  an  anti- 
the'^Tockii  tuberculosis  society  for  a  mental  examination. 
Worker  jj^  ^^^  brought  by  his  mother,  who  was  also  suf- 
fering from  tuberculosis.  Inquiry  revealed  the  fact  that 
the  father  was  in  an  even  more  advanced  stage  of  con- 
sumption, but  was  compelled  to  peddle  for  a  daily  living. 
Charitable  societies  were  furnishing  fresh  eggs  and  fresh 
milk  for  the  consumptive  patients.  The  food  was  divided 
between  the  sick  and  well  members  of  the  family.  The 
boy  received  a  cup  of  milk  and  one  egg  boiled  for  breakfast, 
one  cup  of  milk  about  ten  o'clock,  often  no  midday  lunch 
and  usually  only  coffee  for  supper.    He  refused  to  take  his 


CONSTITUTION  OF  THE  CLINIC  43 

eggs  raw  because  he  liked  them  boiled.  During  the  day- 
he  was  away  from  home  on  the  streets,  no  one  knew  where, 
doing  odd  jobs,  smoking  cigarettes  and  eating  candy  or 
cakes  when  he  could  procure  them.  Naturally  he  had  no 
appetite  at  night  for  wholesome  food. 

Under  conditions  like  these,  it  was  impossible  to  secure 
satisfactory  reactions  to  mental  tests.  Judging  by  his 
postur(>,  carriage,  inattention,  response  to  particular 
stimuli  and  liability  to  fatigue,  the  boy  was  far  from  normal 
mentally.  But  could  not  his  retardation  be  accounted  for 
by  his  disease  and  by  his  home  surroundings?  Or,  on  the 
other  hand,  was  he  congenitally  deficient  through  tuber- 
cular inheritance?  Observation  under  proper  conditions, 
with  regular  diet  and  hygienic  treatment,  was  necessary 
before  any  final  classification  of  the  boy's  mental  status 
could  be  made. 

How  to  secure  such  conditions  was  the  next  question. 
The  family  were  foreigners.  Both  the  father  and  the 
mother  were  wholly  incapable  of  enforcing  hygienic  dis- 
cipline even  if  their  ignorance  did  not  preclude  their  appre- 
ciating the  need  of  it.  Yet  measures  must  be  taken 
promptly  if  anything  was  to  be  done. 

The  demand  for  the  social  worker  was  peremptory. 
Accordingly  she  immediately  visited  tiie  home,  insisted 
upon  some  housecleaning,  advised  unlimited  fresh  air, 
frightened  the  boy  into  temporary  better  behavior  and 
aroused  a  little  better  conception  of  parental  responsibil- 
ity in  the  father  and  the  mother.  Recognizing  these  as 
temporary  measures,  and  the  neighborhood  as  impossible 
for  any  measurable  betterment  of  the  boy's  physical  con- 
dition, she  laid  the  matter  before  several  aid  societies  and 
quickly  had  the  boy  removed  to  the  country  home  where 
he  received  the  treatment  and  environment  necessary  to 


44       THE  CONSERVATION  OF  THE  CHILD 

arrest  the  progress  of  his  disease.  All  of  her  work  was 
necessarj^  and  preliminary  to  the  mental  classification  of 
the  boy,  and  as  such  was  directed  by  the  Psychological 
Clinic. 

As  the  work  of  the  clinic  grows,  the  social  worker  will 
be  brought  into  one  more  field  of  duty,  namely,  the  organ- 
ization and  training  of  a  group  of  volunteers.  Here  again 
her  administrative  and  executive  ability  will  be  called  on. 
If  she  can  furnish  these  qualities  she  will  be  able  to  develop 
for  many  philanthropically  inclined  persons  a  field  of 
activity  in  which  they  can  use  their  time  most  valuably 
for  an  all  too  much  neglected  class  of  helpless  human  beings. 
Already  some  very  good  work  has  been  done  in  this  field 
by  volunteers. 

The  Recorder. — Connected  with  the  staff  there  is 
also  a  recorder,  who  is  an  expert  stenographer,  and  who 
takes  accurate  notes  of  the  examinations  of  each  child, 
records  them  in  a  prescribed  form  and  files  them  in  a 
regular  systematic  way,  ready  for  examination  at  any 
time  by  students  and  others  interested  in  scientific  re- 
search upon  problems  connected  with  children.  Usually 
a  young  woman  fills  the  position. 

In  addition  to  her  stenographic  ability  she  must  be 
familiar  with  methods  of  filing,  acquire  or  possess  a  vocab- 
ulary of  the  technical  terms  used  in  reporting  cases,  and 
should  be  able  to  use  judgment  in  including  intrinsic  or 
omitting  extraneous  matter.  Verbal  reports  are  often 
very  voluminous  and  contain  much  that  is  irrelevant. 
The  examiner  does  not  always  have  the  time  to  say  just 
what  should  be  included  in  the  written  reports,  and  there- 
fore must  rely  upon  the  judgment  of  the  recorder. 


III. 

THE  PSYCHOLOGICAL  CLLNIC:  ITS  FUNCTION   AND 
ITS  FIELD 

The  Psychological  Clinic  is  Not  an  Experiment 
Station. — To  the  mind  imbued  with  the  ordinary  notions 
of  p.^ychology  as  a  more  or  less  abstract  science  a  Psy- 
chological Clinic  suggests  immediately  the  means  of 
organization  provided  to  gather  scientific  information 
concerning  abnormal  or  aberrant  minds.  Consonant  with 
this  conception,  the  clinic  is  thought  to  be  merely  an 
experimental  station,  or  a  psychological  laboratory 
wherein  interest  with  the  human  subject  ceases  with  the 
record  of  his  reaction.  Such  a  view  is  to  a  certain  degree 
erroneous.  The  clinic  is  not  merely  an  experiment  sta- 
tion nor  merely  part  of  a  psychological  laboratory.  It  is 
something  more  and  something  different  in  purpose  and 
organization. 

Neither  is  it  a  Training  School. — Another  and  more 
prevalent  view  held  by  many  classifies  the  clinic  as  a 
training  school.  Here  again  the  view  is  partially  true  but 
primarily  erroneous.  Pedagogical  advice  is  indeed  freely 
dispensed  in  many  cases  and  pedagogical  training  is  su- 
pervised in  many  others,  but  the  primary  purpose  of  the 
clinic  is  not  teaching.  While  it  maintains  always  a  very 
close  and  active  relationship  with  all  schools,  it  would  be 
misleading  to  confound  the  two  organizations  in  purpose, 
functions,  or  results.  The  clinic  comprises  a  school  and 
other  features  as  well.  It  is  more  than  a  school  in  that  it 
aims  at  a  larger  result  than  a  school  would  do,  and  attains 
its  results  by  methods  far  more  varied  than  any  peda- 
gogics yet  applied. 

45 


46       THE  CONSERVATION  OF  THE  CHILD 

The  Clinic  Ministers  to  Every  Special  Child. — The 

clinic  takes  on  such  manifold  and  divergent  forms  of 
service  and  embraces  such  a  wide  field  of  subjects  that  it 
is  practically  impossible  from  description  alone  to  furnish 
an  adequate  idea  of  its  numerous  activities.  In  brief,  its 
function  is  to  restore  the  special  child  to  normality  or  as 
near  normality  as  possible.  Its  field  includes  every  special 
child.  Its  services  are  free  to  all  of  them.  It  is  an  ortho- 
genic agency  in  the  widest  sense  of  the  term,  devoted  to 
restoring  abnormal  children  to  normal  intellectual  or 
moral  capacities,  or  ameliorating  their  condition  as  far 
as  circumstances  will  permit.  In  doing  this  it  directly 
ministers  to  the  needs  of  the  whole  child.  No  item  of 
health  is  too  remote  to  be  neglected  or  overlooked.  The 
clinic  diagnoses  mental  or  moral  ills,  dispenses  pedagog- 
ical advice,  supervises  training  and  follows  up  the  case 
until  the  child  has  secured  all  the  aid  that  modern  science 
and  modem  philanthropy  can  give.  In  performing  such 
service  it  calls  into  cooperation  all  child-welfare  agencies 
A  Federating  withiu  reach.  In  this  respect  it  is  a  great  feder- 
Agency  ating  agcucy  focusing  upon  special  children — 

morally  or  mentally  sub-normal  or  super-normal — the 
already  existing  forces  of  society,  and,  whenever  necessary, 
supplementing  these  by  adopting  new  methods  and  meas- 
ures from  the  science  of  psychology.  Throughout  it  all, 
it  maintains  a  scientific  spirit.  In  every  department  of 
its  service  the  most  advanced  methods  science  has  to  offer 
are  brought  to  bear, — in  mental  diagnosis,  in  turning  to 
the  latest  surgical  and  medical  experience  for  relieving 
physical  obstructions  to  mental  growth,  in  applying  the 
most  advanced  pedagogical  methods  of  individual  in- 
struction to  mind-development,  and,  finally,  in  the  storing 
of  the  knowledge  gained  in  each  case  in  such  forms  as  to 
make  it  readily  available  for  research  work.    These  few 


THE  PSYCHOLOGICAL  CLINIC  47 

and  brief  enumerations,  not  descriptive  but  suggestive 
only,  must  here  serve  to  give  a  rapid  nnd  cursory  view  of 
the  dinic's  functions.  If  all  its  multifarious  duties  and 
activities  could  be  expressed  in  one  phrase  which  at  the 
same  time  would  express  its  nature  by  its  essential  func- 
tion, tlu^  clinic  could  probably  best  be  denominated  "a 
clearing  house  for  special  children."  In  the  following 
chapters  these  matters  will  be  dealt  with  more  in  detail. 

Its  Function  is  Both  Scientific  and  Practical. — For 
a  brief  consideration  in  this  chapter  the  functions  of  the 
clinic  may  be  conceived  as  at  once  scientific  and  practical. 
Theoretically  the  two  functions  may  be  conceived  as  co- 
ordinate, or  one  or  the  other  may  be  assigned  a  primacy  in 
importance  according  to  the  logical  exigencies  of  the  matter 
in  hand.  In  practice  there  is  no  hesitancy  about  assign- 
ing the  practical  function  to  the  place  of  primary  activity. 
Every  child  who  comes  to  the  clinic  comes  for  help.  The 
parents,  guardians,  teachers,  societies, — all  who  bring 
children  for  diagnosis  and  advice, — are  confronted  with 
the  practical  disposal  of  their  charges  and  all  of  them  want 
to  know  what  to  do.  From  this  point  of  view  statistics 
are  secondary  in  importance.  Happily,  these  two  func- 
tions are  in  no  wise  mutually  exclusive.  Both  can  subsist 
side  by  side  without  interfering  with  the  greatest  possible 
amount  of  relief  to  each  child  or  with  the  accurate  com- 
pilation of  data.  In  fact,  the  highest  development  of  both 
functions  leads  to  the  best  results  on  the  whole. 

The  two-fold  function  may  be  further  analyzed  into 
various  fairly  definite  tasks.  Among  these  are  collection 
and  filing  of  data;  the  development  of  the  best  Tasks  of  ^ 
clinical  tests  for  measuring  the  mentality  of  '^leChmc 
children;  the  training  of  teachers  and  social  workers  for 
service  among  mental  defectives;  the  diagnosis  of  mental 
diseases;    and    the    most    expeditious    and    satisfactory 


48       THE  CONSERVATION  OF  THE  CHILD 

methods  of  connecting  backward  children  with  the  proper 
sources  of  aid  for  reUeving  or  amehorating  their  condition. 
Manifestly    all    of    these    activities    cannot    be    fairly- 
treated  within  the  compass  of  one  monograph,  and  there- 
fore some  must  be  omitted  from  any  minute  consideration 
in  the  present  work.    Notable  among  these  omissions  will 
be  the  special  training,  observation  and  daily  care  admin- 
istered by  the  clinic  through  the  Hospital  School.    While 
much  reducing  the  magnitude  of  our  descriptive  task, 
this  procedure  will  still  leave  a  large  amount  of  detail  to 
be  handled  in  a  brief  space.    In  order,  however,  to  give  a 
reasonably  consistent  picture  of  clinic  operations,  an  effort 
will  be  made  to  describe  all  the  major  and  minor  activities, 
as  nearly  as  possible  in  the  relation  in  which  they  occur  in 
actual  practice,  but  some  with  greater  detail  than  others. 
At  the  same  time  the  endeavor  will  also  be  made  to  lift 
the  clinic  clear  of  its  multitudinous  duties  and  its  intri- 
cate relations  and  to  present  it  as  a  perfectly  definite 
social  entity,  with  a  unique  function,  a  clearly  circum- 
scribed field,  and  a  thoroughly  practicable  end.     To  a 
large  extent,  the  activities  to  be  described  may  be  grouped 
about  the  central  function  of  mental  classification,  and 
for  the  sake  both  of  clear  presentation  and  of  economy  of 
space,  this  monograph  will  so  treat  them. 

The  Task  of  Collecting  Scientific  Data.— The  task 
of  collecting  scientific  data,  though  but  briefly  touched 
upon  here,  is  vital  to  the  practical  work  of  the  clinic  and 
of  great  present  and  future  value  to  psychology  as  a  whole 
and  especially  to  its  abnormal  phases.  Studies  of  indi- 
vidual children  by  the  best  scientific  methods  under  the 
directions  of  specialists  are  being  constantly  made.  The 
data  so  gathered,  with  all  the  collateral  data  coming  in 
from  all  the  varijous  classifications  by  specialists  in  other 


THE  PSYCHOLOGICAL  CLINIC  49 

clinics,  with  the  social  worker's  report  based  upon  a  per- 
sonal inspection  of  the  home,  the  pedagogical  reports 
consisting  of  samples  of  writing,  spelling,  and  manual 
work  of  the  child,  with  the  photographs,  dental  and  facial 
casts,  are  all  carefully  classified  and  filed  for  future  refer- 
ence at  the  University  of  Pennsylvania.  Over  six  hundred 
are  on  file  at  the  present  time  and  the  material  contained 
in  them  is  already  becoming  of  great  scientific  value.  As 
time  passes  and  the  collection  increases  the  value  of  such 
documents  will  increase  in  a  greater  ratio. 

The  Testing  of  Mental  Tests. — For  purposes  of 
classification  many  tests  and  systems  of  tests  are  being 
tried  out.  Some  are  being  rejected  and  new  ones  dis- 
covered. Many  tests  which  may  be  entirely  applicable  in 
other  places  and  for  other  purposes  are  not  practicable  at 
a  psychological  clinic  examination.  The  quantity  of 
apparatus  demanded,  the  length  and  intricacy  of  the  test 
itself,  the  amount  of  book  knowledge  and  special  training 
necessary  for  the  examiner  himself,  or  the  amount  of 
intelligence  assumed  to  reside  in  the  child  under  examina- 
tion may  make  a  test  of  mentality  useless  for  clinic  work. 
This  application  and  development  of  tests  is  comparatively 
new  by  reason  of  the  short  history  of  the  psychological 
clinic  itself,  but  it  will  eventually  furnish  a  valuable  and 
prolific  source  of  scientific  investigation. 

The  Training  of  Psychoclinicists. — Another  new  de- 
parture found  to  ])e  necessary  by  experience  is  training 
psychologists    to    become    examiners    in    psychological  I 

clinics,  training  teachers  for  backward  and  defective  chil- 
dren, and  training  social  workers  for  service  in  connection 
with  hospital  clinics.  In  the  first  field,  graduate  students 
in  psychology  are  finding  a  new  line  of  progress  analogous 
to  the  laboratory  experimentation  in  systematic  psychol- 
4 


50       THE  CONSERVATION  OF  THE  CHILD 

ogy.  Their  natural  bent  for  scientific  investigation  takes 
the  very  practical  form  of  the  study  and  classification  of 
mentally  defective  children,  in  which  are  involved  prob- 
lems sufficiently  intricate  and  sufficiently  deep  for  any 
intellect,  and  at  the  same  time  methodical  enough  to  give 
the  requisite  training  for  original  research. 

In  addition  to  this  scientific  opportunity,  the  demand 
arises  not  only  from  psychological  clinics,  but  for  psychol- 
ogists as  examiners  to  insane  asylums,  juvenile  courts, 
charitable  organizations,  and  other  institutions  working 
for  the  welfare  of  children.  The  mental  condition  of 
children  everywhere  is  being  considered  as  it  never  was 
before,  and  the  need  of  expert  ability  to  decide  upon  the 
causes  of  mental  and  moral  deviation  is  becoming  apparent 
in  all  these  fields  of  activity. 

The  Training  of  Special  Teachers  and  Social 
Workers. — The  extension  of  the  training  of  backward 
children,  both  in  the  public  schools  and  private  institu- 
tions, has  created  a  demand  for  certain  kinds  of  teachers. 
The  ordinary  grade  teacher  of  a  public  school,  with  the 
talents  which  she  usually  possesses,  is  perfectly  adapted 
to  such  work  providing  she  can  first  secure  the  necessary 
grounding  in  psychology  and  a  practical  experience  for 
this  new  work.  Both  of  these  opportunities  the  psycho- 
logical clinic  can  readily  furnish. 

To  the  social  workers  a  new  field  has  been  opened  in 
connection  with  hospitals  and  clinics.  To  meet  the  de- 
mand the  Psychological  Clinic,  through  its  social  service 
department,  enables  those  who  wish  it  to  secure  the  neces- 
sary practical  experience  required  in  such  work,  and  at 
the  same  time  through  courses  in  child  psychology  to  add 
to  their  practical  training  the  theoretical  knowledge  re- 
quired in  any  work  with  children. 


THE  PSYCHOLOGICAL  CLINIC  51 

The  Supervision  and  Education  of  Special  Children. 

— Involved  in  what  we  have  called  the  practical  side 
of  the  clinic  functions,  among  which  classification  is  the 
chief,  are  several  other  minor  yet  necessary  activities  for 
making  the  most  expeditious  final  disposal  of  not  a  few 
cases.  One  of  these  is  the  supervision  of  pedagogical 
instruction  and  moral  training  where  cither  is  necessary 
to  determine  the  mental  or  moral  condition  of  the  child 
under  investigation.  To  this  end  the  clinic  administers 
directly  to  the  teachers,  parents  or  guardians  in  charge  of 
backward  children  advice  which  they  can  follow  out  in 
the  home,  or  at  such  other  places  as  may  be  suitable.  In 
this  way  the  clinic  becomes  an  educational  dispensary. 

Supervision  must  be  continued  as  long  as  doubt  exists 
upon  the  question  of  mentality,  often  for  months  or  even 
years.  Upon  such  training,  and  upon  judgment  based  on 
its  results,  sometimes  depends  the  future  of  the  child, 
whether  his  remaining  years  will  be  spent  in  an  institution 
or  a  few  of  them  in  some  special  school  with  the  prospect 
of  his  ultimate  return  to  a  normal  social  life. 

One  clinic  case,  a  boy  addicted  to  stealing,  was  under 
various  modes  of  trabaing  for  nearly  three  years,  and  at 
one  time  almost  sent  to  a  reformatory  as  hope-  illustrative 
less.     The  scale  was  finally  turned  in  favor  of  ^^^^ 

mere  temporary  badness  and  the  boy  to-day  is  creditably 
and  faithfully  filling  a  position  in  a  business  house,  though 
he  is  yet  so  young  that  final  judgment  cannot  be  pro- 
nounced. A  similar  situation  obtains  with  a  mentally 
retarded  girl  who  first  was  examined  in  the  summer  of 
1908,  and  who  since  that  time  has  been  under  the  most 
expert  training  and  observation  without  yet  yielding  a 
satisfactory  account  of  her  true  mentality.  In  this  t^x- 
ceedingly  baffling  case,  possibly  ten  years  more  will  be 


52       THE  CONSERVATION  OF  THE  CHILD 

required  to  settle  finally  the  theoretical  classification  of 
the  child.  Happily,  in  such  instances  where  the  doubtful 
cases  fall  into  the  good  hands  of  the  •  clinic,  and  are  not 
left  to  the  ignorant  neglect  or  to  the  equally  unintelligent 
domination  of  parents  or  guardians,  no  time  is  lost  in  the 
development  of  the  children  and  no  injury  done  by  false 
methods  of  training.  For  such  cases  the  Hospital  School 
is  an  invaluable  aid  to  the  clinic. 

A  further  activity  grows  naturally  out  of  the  one  just 
described.  In  many  instances  where  children  carmot  be 
entered  in  the  Hospital  School,  the  clinic  through  its 
social  worker  supervises  the  administration  of  medical 
treatment  under  the  direction  of  a  physician  and  secures, 
if  possible,  improvement  in  diet,  sleep,  bathing  and  other 
essentials  of  hygiene,  at  the  child's  home  or  in  some 
temporary  charitable  institution.  Such  action  is  often 
indispensable  to  a  final  mental  classification  by  excluding 
physical  factors.  The  good  offices  of  the  same  social 
worker  are  often  used  to  secure  admission  to  asylums  or 
schools  for  the  children  needing  institutional  care,  thus 
finally  disposing  of  such  cases. 

Its  Central  Function  is  Mental  Diagnosis. — All  of 
these  educative,  remedial,  and  restorative  measures  are 
logical  auxiliaries  to  the  great  orthogenic  purpose  of  the 
clinic  and  minister  directly  to  the  welfare  of  the  atyp- 
ical child,  cither  of  this  generation  and,  indirectly,  by 
training  new  workers  in  this  field,  to  the  welfare  of  suc- 
ceeding generations.  This  supreme  mission  of  the  clinic 
to  all  special  children,  its  present  far-reaching  and  ever- 
increasing  scope  of  usefulness,  must  never  be  lost  sight  of 
while  the  mind  is  occupied  with  any  of  its  phases.  Mental 
classification  is  important,  even  necessary,  for  correctly 
dealing  with  any  case  of  mental  or  moral  deviation,  but 


THE  PSYCHOLOGICAL  CLINIC  53 

it  is  not  the  whole  activity  of  the  clinic.  So  closely  knit 
are  the  various  processes  of  the  clinic  that  almost  any 
important  one  of  many  might  be  chosen  as  the  centre 
around  which  to  group  the  others.  Our  choice  is  made  for 
purposes  of  description  and  the  best  that  can  be  said  is 
that  it  does  not  increase  the  confusion  of  a  reader  unac- 
quainted with  the  operation  of  a  psychological  clinic. 
So  large  a  place,  however,  does  mental  diagnosis  play  in 
the  total  activities  of  the  clinic  that  upon  it  rests  a  large 
share — though  not  all — of  the  social  importance  won  by 
the  clinic.  Let  us  examine  a  little  more  closelj^  into  this 
phase  of  the  matter. 

Mental  Diagnosis. — A  mental  diagnosis,  in  brief,  is 
the  classification  of  an  exceptional  child  according  to  his 
mental  capacity.  A  clinic  diagnosis  places  emphasis  upon 
individual  examination.  For  the  word  "clinic"  springs 
from  an  etymological  root  meaning  "bed,"  and,  in  strict 
consistency  with  the  original  meaning  of  the  word,  the 
clinic  should  deal  with  the  patients  reclining  in  bed. 
This,  of  course,  is  not  done  in  a  psychological  clinic.  Actual 
practice  here,  as  elsewhere,  has  modified  the  meaning  of 
the  term  and  has  retained  chiefly  that  portion  of  its  sig- 
nificance, clearly  only  incidental,  whicli  connected  indi- 
vidual treatment.  The  action  of  time  and  force  of  circum- 
stances have  therefore  minimized  what  was  once  primary 
and  magnified  what  was  once  secondary. 

It  is  with  tiie  individual  then — the  whole  individual — 
that  the  psychological  clinicist  deals  in  making  his  diag- 
nosis or  mental  classification.  No  one  symptom  or  group 
of  symptoms  representing  disease  of  some  organ  or  group 
of  organs  is  to  be  recognized  and  treated.  By  the  very 
nature  of  the  case  every  functional  derangement  and 
anatomical  abnormality  discoverable  by  the  most  careful 


54       THE  CONSERVATION  OF  THE  CHILD 

and  comprehensive  examination  of  the  whole  subject  in 
his  physical,  mental,  and  social  nature  must  be  taken 
into  full  account  and  be  given  its  due  place  in  the  final 
conclusion. 

In  this  respect  of  the  complete  scrutiny  of  individual 
cases,  the  work  of  the  psychological  clinic  is  sharply  dif- 
ferentiated from  the  medical  inspection  of  school  children, 
whether  made  upon  single  pupils  or  upon  groups  of  pupils. 
In  point  of  thoroughness  the  two  operations  are  hardly 
comparable,  though  they  can  be  made  mutually  supple- 
mentary and  more  effectual  by  using  the  method  of  group 
inspection  for  discovering  and  sending  all  children  sus- 
pected of  mental  defect  to  the  clinic  for  final  classification. 

The  Danger  of  Unskilled  Mental  Diagnosis. — By 
this  individual  and  comprehensive  examination  the  clinic 
offers  itself  as  a  place  where  a  free,  full,  and  careful  mental 
diagnosis  can  be  had  for  any  suspected  child,  with  the 
assurance  to  the  parents  or  guardians  that  the  work  will 
be  conducted  by  experts  specially  prepared  by  training  and 
experience  for  the  work.  Much  mischief  has  been  wrought 
in  the  past  by  well-meaning  but  unfit  persons  with  their 
off-hand  relegation  of  backward  children  to  the  general 
class  of  "feeble-minded"  or  "moral  degenerates"  without 
intelligent  examination  of  the  cases  or  just  appreciation 
of  the  meaning  or  the  consequences  of  the  term  applied. 
For  one  thing,  the  pronouncement  by  any  influential  per- 
son that  a  child  is  morally  or  mentally  abnormal,  under 
the  present  conditions  of  ignorance  and  prejudice  of  so- 
ciety, lays  upon  the  child  an  undeserved  and  wholly  unjust 
odium.  Often,  too,  such  a  statement  paralyzes  all  efforts 
to  help  the  child  so  condemned.  The  willing  but  unin- 
formed parent  deems  all  effort  at  further  education  useless. 
The  avaricious  and  the  needy  parent  sees  a  possibility  of 


THE  PSYCHOLOGICAL  CLINIC  55 

removing  the  child  from  school  and  putting  him  to  work. 
The  ambitious  parent  is  completely  discouraged  in  his 
plans  for  the  future  of  the  child.  All  agree  that  if  the 
child  is  an  imbecile  it  is  useless  to  try  to  mend  the  ^^^  ^^^^^ 
work  of  Providence,  that  the  will  of  God  should  paVilua 
be  accepted  with  resignation.  A  case  is  on  record 
of  the  entire  neglect  of  a  child,  the  daughter  of  a  well-to- 
do  professional  man,  until  about  her  eighth  year,  when  she 
was  mentally  equal  to  a  high-grade  idiot,  gibbering  in  the 
comer  of  a  room,  unable  to  speak  more  than  three  words, 
much  less  to  read,  wTite  or  perform  the  usual  acts  of  a 
child  of  her  age.  After  about  one  year  of  training  she  had 
almost  overcome  her  echolalia,  could  speak  in  simple 
sentences,  answer  ordinary  questions  intelligently,  read 
in  a  primer,  write  a  few  words,  and  conduct  herself  with 
the  manner  of  a  little  lady. 

Society,  as  a  whole,  is  as  indifferent  to  the  fate  of  its 
feel)le-minded  members  as  individuals  often  appear  to  be. 
The  teacher  frequently  pronounces  them  unfit  ^^^.^^  ^^^^ 
and  the  school  turns  them  out.  The  parents  may  g|g*^fi^^g*5 
neglect  them  to  the  point  of  cruelty  but  not  be- 
yond. The  weak-minded  among  the  poor  may  roam  the 
streets,  as  they  frequently  do  in  large  cities;  they  may  eke 
out  the  family  income  by  gathering  wood  and  coal  wherever 
the  fuel  can  be  found;  they  may  beg  for  pennies,  clothes,  or 
meals;  they  may  from  year  to  year  degenerate  into  deeper 
idiocy  and  the  depravity  of  petty  vices,  but  as  long  as  they 
and  their  guardians  keep  within  the  pale  of  the  law  as  it  ai> 
plies  to  normal  persons  in  full  possession  of  their  senses,  no 
one  can  interfere  to  compel  an}^  effective  effort  toward  the 
permanent  amelioration  of  the  dement's  condition  or  to 
protect  society  from  the  inevitable  effects  of  its  own  neg- 
lect.   If  this  is  not  universally  true  in  America  in  theory, 


56      THE  CONSERVATION  OF  THE  CHILD 

it  is  almost  universally  true  in  practice.  And  what  is  more 
and  what  is  worse,  the  state  institutions  for  feeble-minded 
are  so  crowded  that  when  philanthropic  efforts  are  made 
to  secure  an  unfortunate's  best  welfare  by  entering  him 
in  the  proper  institution,  a  long  waiting  list  of  previous 
applicants  effectually  blocks  the  well-intentioned  plan. 

The  Psychological  Clinic  Makes  an  Expert  Diag- 
nosis.— The  psychological  clinic  makes  a  real — in  fact,  a 
ffuasi  official — diagnosis.  This  at  least  is  the  usual  effect. 
Those  who  bring  the  children  feel  that  time  and  skill  in 
full  measure  have  been  devoted  to  the  problem  and  that 
the  pronouncement  is  valid  and  the  advice  good.  Usually, 
therefore,  instead  of  entirely  neglecting  their  charges  or  else 
dubiously  spending  their  energies  in  half-hearted  attempts 
to  aid  them,  they  willingly  follow  the  directions  given  and 
bend  their  energies  to  persistent  and  effective  efforts  to 
benefit  them.  Few  persons  realize  the  weary  years  and 
wasted  money  spent  by  some  sacrificing  people  in  mis- 
guided attempts  to  help  their  children.  One  charitable 
organization  is  reported  to  have  placed  a  bo}"  in  its  charge 
in  ten  different  families,  having  him  cast  back  on  their 
hands  ten  times  before  it  was  discovered  by  examination 
that  he  was  an  imbecile.  Case  C.  F.  was  brought  by  his 
aunt  to  the  clinic  when  he  was  eighteen  years  old  and  an 
idio-imbecile.  The  good  lady  had  spent  all  her  income 
for  years  and  much  of  her  principal,  and  had  wasted 
practically  all  her  life  in  weary  peregrinations  from  school 
to  school  and  trainer  to  trainer  seeking  advice  for  her 
nephew.  From  not  wholly  disinterested  people  she  had 
received  reports  of  his  mentality  stating  that  the  boy 
possessed  all  degrees  of  intellectuality  from  "very  bright" 
to  "  hopelessly  idiotic,  with  pressure  on  the  brain  and  the 
certainty  of  dying  before  he  was  thirty."     It  is  of  little 


THE  PSYCHOLOGICAL  CLINIC  57 

wonder  that  the  poor  woman  was  almost  as  much  dis- 
tracted as  her  nephew. 

But  the  clinic  does  more  than  merely  classify.  If 
ignorant  or  careless  parents  fail  to  follow  the  advice  given, 
the  clinic  possesses  the  means  through  its  social  service 
department  of  following  up  such  cases  with  unremitting 
efforts  until  it  secures  finally  for  the  child  the  treatment  he 
should  have.  In  two  ways  then  the  clinic  offers  society 
the  most  efficient  means  yet  organized  for  dealing  deci- 
sively with  its  exceptional  children:  first,  classification  that 
is  a  bona  fide  diagnosis;  and  second,  a  follow-up  system 
that  accomplishes  results. 

A  Diagnosis  Prevents  Neglect. — In  this  perfectly 
defined  sphere  its  services  are  indispensable  in  theory  as 
well  as  prai^tice.  For  a  backward  or  mentally  defective 
child  will  suffer  from  cither  one  or  the  two  alternative 
courses — neglect  or  overtraining.  If  neglected  at  home 
and  misunderstood  at  school  under  the  vague  and  vain 
delusion  that  he  "will  outgrow  his  dulness,"  the  feeble- 
minded child  is  allowed  to  roam  the  streets  at  will,  he 
speedily  picks  up  the  bad  habits  to  which  his  class  is  so 
prone,  and  steadily  deteriorates  mentally  and  physically 
until  a  precocious  aptitude  for  crime  lands  him  in  some 
penal  institution  or  an  earh'-acquired  shiftlessness  en- 
lists him  in  the  great  army  of  ne'er-do-wells  or  beggars. 
In  either  capacity  he  remains  a  threat  and  a  burden  to 
the  community. 

Several  such  cases  have  come  to  the  notice  of  t  he  clinic. 
A  boy  thirteen  years  old  was  brought  by  tlie  superinten- 
dent of  a  House  of  Refuge  on  account  of  moral  delinquen- 
cies and  backwardness  in  learning.  He  had  been  placed  in 
a  special  class,  but  did  no  better.  At  the  Refuge  he  made 
no  educational  progress. 


58       THE  CONSERVATION  OF  THE  CHILD 

To  mental  progress  was  added  incorrigibility.  He  was 
committed  to  the  Refuge  at  eleven  years  of  age  after  three 
arrests.  The  first  was  made  for  taking  a  horse  to  a  stable 
and  having  it  shod  preparatory  to  a  wild-west  ride.  The 
second  and  third  arrests  occurred  after  his  thieving  opera- 
tions had  been  reduced  from  horse  stealing  to  petty 
larceny,  once  from  a  gas  meter  and  once  from  a  house. 
A  Case  of  After  his  parole  from  the  Refuge  at  the  age  of 
Neglect  thirteen,  trouble  still  pursued  him.  In  school  he 
could  not  learn  even  in  the  first  grade  and  would  not  obey. 
Outside  of  school  his  activities  expressed  themselves  in 
planning  petty  thievings,  the  last  of  which  consisted  in 
purloining  five  nickel-plated  steam  valves,  three  of  which 
he  sold  for  a  few  pennies.  This  escapade  brought  him 
again  into  the  Juvenile  Court,  and,  at  last  report,  he  was 
waiting  sentence  at  the  House  of  Detention. 

One  is  sorely  tempted  to  pause  here  and  ask  the  ancient 
question:  "Who  sinned?  Society  or  the  boy?"  Surely 
an  early  and  proper  diagnosis  of  his  case  would  have 
assigned  him  to  a  training  school  for  mental  defectives 
where  he  would  have  been  trained  in  some  occupation 
suited  for  his  limited  powers,  and  his  familj^  his  teachers, 
truant  officers,  policemen,  courts,  refuges,  and  all  the  other 
misused  forces  of  society  would  have  been  free  to  apply 
themselves  to  better  ends.  But  the  years  have  gone. 
The  boy  has  passed  his  learning  time.  Worse,  he  has 
degenerated  both  in  mind  and  habits.  Henceforth,  soci- 
ety must  keep  him  as  a  delinquent,  or  if  he  goes  free,  suffer 
his  depredations. 

A  Diagnosis  Prevents  Overtraining. — The  opposite 
method  of  treatment  or  overtraining  usually  springs  from 
the  ambition  of  the  parents.  It  is  quite  natural  for  a 
father  or  mother  to  want  a  son  or  daughter  to  profit  by 


THE  PSYCHOLOGICAL  CLINIC  59 

all  parental  experience,  to  avoid  their  mistakes  and  to 
aecomplisli  what  they  failed  to  do.  Knowing  the  best 
side  of  their  children,  and  clinging  to  the  last  shred  of  hope, 
they  are  loath  to  believe  the  child  of  their  ambitious  hopes 
can  not  only  never  realize  them  in  the  remotest  degree, 
but  actually  must  be  assigned  to  that  fearful  class  known 
as  "weak-minded." 

Seizing  upon  the  child's  marvellous  memory  for  obscure 
and  detached  details,  or  upon  its  wonderful  musical 
ability,  the  parents  dwell  upon  these  qualities  to  the 
exclusion  of  all  weaknesses.  To  their  minds  such  a  child 
7nust  be  able  to  learn.  It  must  be  laziness,  or  inattention, 
or  carelessness  that  prevents  advance  in  school.  Having  a 
zeal  without  knowledge,  they  press  the  poor,  weak  brain 
to  tasks  entirely  beyond  it.  They  harass  and  torment 
the  child  until  high-grade  imbecility  falls  to  lower  grades 
or  the  abysmal  gloom  of  idiocy  covers  the  shattered  mind 
and  shields  the  little  one  from  further  persecution. 

Not  long  ago  a  woman  brought  her  daughter  for  exami- 
nation. The  girl  was  twelve  years  old  and  to  the  bitter 
disappointment  of  the  mother,  who  had  been  a  school 
teacher,  she  had  never  been  able  to  pass  the  second  grade 
in  public  school.  The  good  woman,  possessed  with  that 
little  knowledge  which  is  a  dangerous  thing,  told,  with 
tears  in  her  eyes,  all  her  ambitions  for  that  daughter, — 
of  how  she  had  stayed   up  nights  until  one 

A    v/tiSC    Ol 

o'clock,  teaching,  drilling,  beseeching,  scolding  Ovenrain- 
and  promising,  in  the  hopeless  effort  to  give  that 
girl  an  education,  without  which,  the  mother  said,  "a 
person  might  as  well  be  dead."  The  girl  was,  in  fact,  a 
middle-grade  imbecile,  fit  indeed  for  housework  or  other 
manual  occupation  in  which  she  would  have  found  her 
life's  happiness,  but  utterly  destitute  of  the  mentality 


60      THE  CONSERVATION  OF  THE  CHILD 

needed  for  her  mother's  high  ambitions  and  made  con- 
tinually worse  by  her  mother's  constant  forcing. 

Even  more  recently,  a  well-educated  and  fairly  success- 
ful business  man  admitted  that  he  had  long  nursed  the 
am])ition  to  make  his  imbecile  son  a  physician,  and  gave 
it  up  only  when  adolescent  expansion  reached  high  tide 
and  ebbed  again  without  carrying  the  boy  beyond  the 
third  grade  in  school. 

Such  instances  are  too  pathetic  for  adverse  criticism. 
They  grow  out  of  the  best  there  is  in  the  human  heart. 
The  hopes  and  fears,  prayers  and  sacrifices  of  mothers 
and  fathers  for  their  children  are  not  for  a  moment  to  be 
deplored.  It  requires  effort  and  a  determined  purpose  to 
do  for  the  best,  to  disabuse  parents'  minds  of  false  hopes 
and  to  turn  their  energies  in  the  right  direction  for  the 
betterment  of  their  unfortunate  children,  but  it  must  be 
done.  To  do  it  and  to  do  it  early  enough  requires  psychol- 
ogists skilled  in  diagnosis  of  imbecility. 

The  Field  of  Clinic  Operations. — The  foregoing  sharp 
definition  of  the  functions  of  the  clinic  may  seem  to  re- 
strict the  field  of  its  operations.  To  a  superficial  observer, 
or  to  one  unfamiliar  with  the  true  state  of  affairs  regarding 
backward  and  deficient  children,  small  reason  may  appear 
for  the  foundation  of  such  an  institution.  However,  the 
full  force  of  the  necessity  and  the  almost  overwhelming 
demands  to  be  made  upon  its  services  will  be  gathered 
from  a  careful  consideration  of  statistics  both  of  the 
curable  and  incurable  backward  cases  of  mental  or  moral 
deviation  recorded  or  estimated. 

The  Extent  of  Retardation  in  Public  Schools  of 
America. — In  the  last  few  years  increasing  consideration 
has  been  given  to  the  whole  problem  of  backwardness  or 
retardation  in  public  schools.    What  is  meant  by  "back- 


THE  PSYCHOLOGICAL  CLINIC  61 

wardness"  and  "retardation"  will-  be  explained  later. 
Just  now  we  arc  concerned  with  the  facts  discovered  by 
statistical  inquiry  made  in  a  number  of  larger  and  smaller 
school  systems  of  the  United  States. 

Early  Investigation  of  Retardation  in  Schools. — As 
early  as  1872  Dr.  William  T.  Harris  called  attention  to 
retardation  in  the  public  schools  of  St.  Louis.  Superin- 
tendent Maxwell  of  New  York  City,  in  his  annual  report 
for  1904,  showed  that  39  per  cent,  of  the  pupils  in  the 
primary  grades  were  above  normal  age.  These  prelimi- 
nary motives  were  followed  by  Superintendent  James 
E.  Bryan's  investigations  into  the  public  schools  of 
Camden,  N.  J. 

Reports  of  1905-06  show  that  in  that  city  the  percent- 
age of  children  two  years  or  more  behind  the  grades  proper 
for  their  ages  was  as  follows:  first  grade,  1S%  camden 
per  cent. ;  second  grade,  24  per  cent. ;  third  grade,  Reports 
33  per  cent.;  fourth  grade,  38}^  per  cent.;  fifth  grade,  35 
per  cent.;  sixth  grade,  30  per  cent.;  seventh  grade,  32% 
per  cent.;  eighth  grade,  14^-^  per  cent.;  and  an  average  of 
all  grades  of  26^  per  cent.,  or  more  than  one-quarter  of  the 
entire  school  enrolment.^  His  figures  show  further  that 
for  1905-06,  72  per  cent,  of  all  the  pupils  were  at  least 
one  year  older  than  the  age  assumed  by  that  particular 
school  system  as  the  standard  age  for  each  of  the  several 
grades;  47  per  cent,  were  more  than  one  year  older;  25 
per  cent,  were  more  than  two  years  older,  and  12  per  cent, 
were  more  than  three  years  older. 

1  A  Method  for  Determining  the  Extent  and  Causes  of  Retarda- 
tion in  a  City  School  System,  James  E.  Bryan,  The  Psychological 
Clinic,  vol.  i,  No.  2,  April  15,  1907,  pp.  41,  42. 

Also  see  artirlc  "The  Need  for  Special  Classes  in  the  Public 
Schools,"  J.  D.  Heilman,  The  Psychological  ^Jliiiic,  vol.  i,  No.  4, 
June  15,  1907,  pp.  104-114. 


62       THE  CONSERVATION  OF  THE  CHILD 

Five  city  school  systems  were  investigated  by  Dr. 
Comman.  "The  actual  number  of  children  of  each  age  in 
each  grade  is  given  for  these  cities  in  the  following  order: 
Camden,  Kansas  City,  Boston,  Philadelphia,  New  York. 
It  will  appear  that  the  five  cities  bring  under  considera- 
tion 755,928  children,  approximately  5  per  cent,  of  the 
children  in  the  elementary  schools  of  the  United  States. 
If  we  follow  Superintendent  Bryan  and  regard  a  first-grade 
child  of  seven  years  of  age  or  over  as  beyond  the  theo- 
retical age  limit  for  that  grade,  and  a  second-grade  child 
Retardation  of  eight  ycars  as  over  and  beyond  the  theoretic 
feho'oT  age  limit  for  that  grade,  and  so  on  throughout 
Systems  ^^^  grades,  we  find  61  per  cent,  of  the  children 
beyond  this  age  limit.  Boston  has  the  smallest  percent- 
age, 51  per  cent.,  and  Kansas  City  the  largest  percentage, 
77.6  per  cent.  If  with  Dr.  Maxwell  we  use  the  term  '  above 
normal  age'  for  a  child  one  year  beyond  his  theoretic  age 
limit,  i.e.,  a  first-grade  child  of  eight  years  or  over,  it 
appears  that  31.6  per  cent,  are  above  normal  age.  Boston 
again  has  the  lowest  percentage,  21.6  per  cent.,  and  Kansas 
City  the  highest,  49.6  per  cent.  If  we  take  Superintendent 
Bryan's  definition  of  a  pedagogically  retarded  child  as 
one  two  years  beyond  the  theoretic  age  limit  for  each 
grade,  then  13.5  per  cent,  are  pedagogically  retarded, 
the  limits  ranging  between  7.3  per  cent,  for  Boston  and 
26.3  per  cent,  for  Camden  and  Kansas  City.  Table  VII 
also  reveals  that  of  the  children  of  these  five  cities,  4.9 
per  cent,  are  three  years  or  more  beyond  the  theoretic  age 
limit,  and  1.5  per  cent,  are  four  or  more  years  beyond  the 
theoretic  age  limit."  ^ 

2  The  Retardation  of  the  Pupils  of  Five  City  School  Systems, 
OHver  P.  Cornman,  The  Psychological  Clinic,  vol.  i,  No.  9,  February 
15,  1908,  pp.  245-257. 


THE  PSYCHOLOGICAL  CLINIC  03 

Dr.  Comman'.s  findings  were  largely  expanded  and  in 
some  measure  corrected  but  not  materially  altered  by 
Dr.  Roland  P.  Falkner,  in  the  May  number  of  the  Clinic 
for  the  same  year.^  In  all  later  instances  where  investiga- 
tions have  been  made,  j^ractically  the  same  state  of  affairs 
has  been  brought  to  light,  and  this  in  spite  of  the  contrary 
opinion  of  some  school  experts  upon  the  subject.  An 
illustration  of  both  the  magnitude  of  retardation  and  the 
unawareness  of  school  men  with  regard  to  conditions  is 
furnished  by  the  following  statement:  "In  an  article  in 
The  Teacher,  December,  1907,  Dr.  Witmer  comments 
upon  this  fact  in  discussing  the  evolution  of  special  classes 
in  the  Philadelphia  schools.  Before  attendance  at  school 
was  enforced  by  law  the  Superintendent  had  reported  that 
there  were  not  enough  backward  children  in  any  neighbor- 
hood in  Philadelphia  to  form  a  special  class.  By  1900 
there  were  reported  1122  children  in  the  schools  too  back- 
ward for  the  usual  grade  instruction."'* 

Later  Investigations. — The  most  recent  utterances 
upon  the  subject  of  retardation  in  public  schools  come 
from  the  investigators  working  upon  the  Russell  Sage 
Foundation.  They  have  taken  up  the  problem  in  the 
United  States  upon  a  basis  commensurate  with  its  magni- 
tude and  importance.  The  results  of  their  researches  into 
thirty-one  cities  in  America  have  been  published  by  Leon- 
ard P.  Ayres,  secretary  of  the  Backward  Children  Investi- 
gation, in  a  volume  entitled  "Laggards  in  Our  Schools." 
It  is  the  latest  as  well  as  the  most  comprehensive  compila- 

^  Some  Further  Considerations  of  the  Retardation  of  the  Pupils 
of  Five  City  School  Systems,  Roland  P.  Falkner,  The  Psychological 
Clinic,  vol.  ii,  No.  3,    May  15,  1908,  pp.  57-74. 

*  Provision  for  Exceptional  Children  in  the  Public  Schools, 
James  H.  Van  Sickle,  The  Psychological  Clinic,  vol.  ii,  No.  4,  June 
15,  1908,  p.  102. 


64       THE  CONSERVATION  OF  THE  CHILD 

tioD  extant  of  facts  and  discussions  of  remedial  measures 
in  America.  Chapter  IV  presents  a  condensed  discussion 
of  backwardness  among  sciiool  children  and  a  summary 
of  results  in  tabular  form.  For  the  thirty-one  cities  the 
percentages  are  as  follows : 

Table  22. — Per  Cent,  of  Retarded  Pupils: 
Thirty-One  Cities. 

Per  Cent. 
City.  Retarded. 

1.  Medford,  Mass 7.5 

2.  Waltham,  Mass 10.6 

3.  Meriden,Conn 13.0 

4.  Quincy,  Mass 17.9 

5.  Aurora,  111 18.3 

6.  Boston,  Mass 18.5 

7.  Maiden,  Mass 18.5 

8.  Fort  Wayne,  Ind 23.3 

9.  Springfield,    Mass 23.3 

10.  Decatur,  111 29.9 

11.  Newark,  Ohio 29.9 

12.  New  York,  N.  Y 30.0 

13.  Portland,  Ore 30.7 

14.  Reading,  Pa 31.6 

15.  Trenton,  N.  J 32.0 

16.  Utica,  N.  Y 32.6 

17.  Woonsocket,  R.  1 35.4 

18.  Troy,  N.  Y 35.6 

19.  Philadelphia,  Pa 37.8 

20.  Wilmington,  Del.  (white) 37.2 

21.  Columbus,  Ohio 37.3 

22.  Los  Angeles,  Cal 38.3 

23.  York,  Pa 38.3 

24.  Kingston,  N.  Y 38.4 

25.  Baltimore,  Md 46.3 

26.  Camden,  N.  J 46.3 

27.  St.  Louis,  Mo 46.6 

28.  Kansas  City,  Mo 48.5 

29.  Memphis,  Tenn.  (white) 51.3 

30.  Cincinnati,  Ohio 58.7 

31.  Erie,  Pa 60.1 

32.  Wilmington,  Del.  (colored) 62.8 

33.  Memphis,  Tenn.  (colored) 75.8 

"It  is  noteworthy  that  the  city  having  the  lowest  per 
cent,  of  retardation  is  Medford,  with  7.5  of  her  pupils  in 


THE  PSYCHOLOGICAL  CLINIC  G5 

that  class.  The  colored  pupils  of  Memphis  show  the 
highest  percentage  of  n^tardation  (75.8)  and  the  figures  are 
based  on  the  enrolment  in  June.  As  was  explained  earlier 
in  the  chapter,  figures  taken  in  September  will  inevitably 
show  a  lower  percentage  of  retardation  than  vAW  similar 
data  gathered  in  June.  Therefore,  it  is  nearly  certam 
that  if  the  data  were  gathered  in  all  cases  on  the  same 
basis  there  would  not  be  so  great  a  discrepancy  between 
the  two  cities  at  the  extremes  of  the  table.  On  the  other 
hand,  it  is  entirely  probable  that  if  all  the  computations 
were  made  on  the  same  basis  Medford  would  still  have  the 
best  record,  and  the  colored  pupils  of  Memphis  the  worst. 

"This  table  is  instructive  in  disclosing  how  important 
a  matter  retardation  is  in  all  the  cities  from  which  data 
are  available.  On  the  average,  approximately  one-third 
of  all  the  children  in  our  city  schools  are  above  the  normal 
age  for  their  grades, — they  are  retarded.  The  table  is 
further  instructive  in  shoeing  what  a  wide  variation  there 
is  in  conditions.  In  the  cities  making  the  best  showing 
the  number  and  percentage  of  retarded  pupils  are  almost 
negligible.  In  the  cities  making  the  poorest  showing  the 
large  majority  of  all  the  children  are  over  age  for  their 
grades. 

"One  of  the  general  conclusions  based  upon  the  figures 
gathered  for  the  whole  country  is  the  following : 

"There  is  a  high  variability  between  cities  in  respect 
to  the  proportion  of  ov(>r-ag(^  children.     Among  Ayres' 

tlie  thirty-one  cities  studied,  Medford,  Massa-  Nummary 
chusetts,  makes  the  best  showing  with  7.5  per  cent, 
of  the  pupils  in  the  above  normal  age  class. 

"The  colored  pupils  of  Memphis  make  the  poorest  show- 
ing with  75.8  per  cent,  above  normal  age.    In  the  thirty- 
one  cities  taken  as  a  whole,  33.7  per  cent,  of  the  children, 
5 


66       THE  CONSERVATION  OF  THE  CHILD 

or  a  trifle  more  than  one-third,  are  above  normal  age  for 
their  grades.  These  figures  probably  represent  with  fair 
accuracy  average  conditions  in  city  school  systems  of  this 
country."  ^ 

The  Latest  Summary. — A  still  later  summary  places 
the  percentage  somewhat  higher.  "A  study  of  the  records 
of  206,495  school  children,"  says  the  same  writer,  "in 
twenty-nine  cities  shows  that  37  per  cent,  of  them  are 
above  the  normal  ages  for  their  grades,  13  per  cent,  of 
these  cases  being  caused  by  late  entrance,  17  per  cent,  by 
slow  progress,  and  the  remaining  7  per  cent,  by  both 
causes  combined."  ^ 

From  the  foregoing  figures  an  increasing  conception  of 
the  enormity  of  the  problem  may  be  gained.  Of  the 
17,061,962  public  school  pupils  reported  by  the  Commis- 
sioner of  Education,  33.7  per  cent.,  or  a  little  more  than 
one-third,  will  probably  leave  school  at  the  legal  limit  of 
age  without  completing  their  common-school  education. 
An  army  of  the  same  total  with  5,740,881  stragglers,  or 
any  army  with  a  like  proportion  of  stragglers,  would  be  a 
perilous  foundation  upon  which  to  base  the  hopes  of  a 
state  for  stability  and  continued  prosperity.  In  demo- 
cratic America  the  school  children  of  to-day  will  form  the 
foundation  of  our  republic  of  to-morrow,  and  one  of  the 
largest  if  not  the  largest  stone  in  the  foundation  of  any 
republic  is  the  intelligence  of  its  citizens. 

Statistics  of  the  Feeble-minded. — Important  as  is  the 
function  of  the  clinic  in  the  treatment  of  children  retarded 
through  curable  physical  defects,  it  is  yet  minor  to  the  less 


"  Laggards  in  Our  Schools,  Leonard  P.  Ayres,  N.  Y.  Charities 
Pub.  Com.,  pp.  45,  46,  48. 

8  The  Relative  Responsibility  of  School  and  Society  for  the  Over- 
Age  Child,  Leonard  P.  Ayres,  Journal  of  Education,  Dec.  21,  1911. 


No  lurther  tests  should  be 
necessarj'  to  show  that  this 
child  is  sutTering  from  mj'opia. 


Adonoid  case.  A  four-inonths- 
old  baby  from  which  adenoids 
were  removed. 


Profile  and  side  view  of  aclenoid 
case. 


A  typical  aileiioid  case. 


THE  PSYCHOLOGICAL  CLINIC  67 

extensive  though  more  intensive  need  of  exact  and  care- 
ful diagnosis  of  mental  deficiency.  Though  they  are  less 
prevalent  than  backwardness  from  curable  physical  de- 
fects, imbecility  and  idiocy  are  present  to  an  almost 
astounding  degree  in  America.  A  sinister  indication  of 
their  real  extent  is  given  in  the  Commissioner  of  Educa- 
tion's Report  for  1909  in  the  statistics  for  state  and  private 
institutions,  from  which  the  following  paragraph  is  taken: 
"Tables  185,  186,  and  187  summarize  the  statistics  of 
the  26  state  schools  and  the  17  private  schools  for  the 
feeble-minded.       The    state    institutions     had   , 

In  America 

17,549  mmates,  only  10,679  bemg  reported  m  a 
school  or  kindergarten.    The  17  private  institutions  had 
927  inmates,  the  number  in  school  or  kindergarten  being 
424.    Tables  188  and  189  give  in  detail  the  statistics  of 
public  and  private  schools  for  the  feeble-minded."  ' 

These  figures,  bad  as  they  are,  do  not  nearly  express 
the  real  state  of  affairs  as  estimated  by  experts.  Though 
all  of  the  state  institutions  are  crowded  and  each  has  a 
long  waiting  list  of  applicants,  there  remain  thousands  of 
unkno^^^l  and  uncounted  mental  defectives  at  large  who 
ought  to  be  segregated  and  sequestered  in  proper  colonies. 

The  Number  of  Mental  Defectives  in  Public  Schools. 
— Wherever  attempts  have  been  made  to  count 
and  to  aid  this  class,  the  investigators  have  been  surprised 
at  the  number.  In  the  Baltimore,  Md.,  schools  a  provi- 
sion for  epileptics  alone  revealed  a  surprising  number  of 
them  in  classes.  The  Superintendent  says,  "Even  after 
the  compulsory  attendance  law  went  into  operation  we 


^  The  report  for  1910  is  not  so  full.  Only  25  states  and  16  private 
institutions  are  reported,  the  former  with  10,678  and  the  latter  with 
892  inmates.  —  Report  of  the  Commission  of  Education  for  year 
ended  June  30,  1910,  vol.  ii,  pp.  21-25. 


68       THE  CONSERVATION  OF  THE  CHILD 

excluded  the  worst  cases;  but  we  are  surprised  to  find  in 
the  spring  of  1907,  on  taking  a  census  of  these  children,^ 
that  we  had  83  of  them  in  school.  Almost  wholly  as  a  ^ 
protective  measure,  and  in  the  interests  of  normal  chil- 
dren, it  was  decided  to  try  experimentally  their  separation 
from  other  children.  There  special  classes  were  authorized 
by  the  Board  and  two  were  organized  early  last  fall." 

Plans  recently  put  into  operation  in  St.  Louis  for  train- 
ing the  distinctly  imbecilic  and  idiotic  children  show  the 
same  prevalence  of  feeble-mindedness  and  necessity  of 
large  expenditure  to  deal  with  it.  "In  Novem- 
ber, 1907,  Superintendent  Soldan  reported  to 
the  Board  of  Education  that  there  were  at  that  time  in 
the  various  public  schools  of  the  city  181  children  so 
mentally  defective  as  to  be  incapable  of  doing  their  regular 
school  work  provided  for  normal  children.  They  were 
not  merely  slow  or  backward  children.  They  were  unable 
to  do  either  the  amount  or  kind  of  work  which  even  a 
slow  child  can  do;  yet  these  children  were  considered 
capable  of  education  with  educational  facilities  adjusted 
to  their  needs,  and  with  constant  supervision  of  their 
physical  condition.  Nine  children  cited  by  Superinten- 
dent Soldan  as  typical  of  the  entire  list  ranged  from  nine 
to  fourteen  and  a  half  years  of  age.  They  had  attended 
school  from  three  to  six  years.  Four  had  not  advanced 
beyond  the  first  grade;  and  only  two  had  advanced  be- 
yond the  second. 

*'  'Nature/  says  the  report,  'puts  the  defective  child  in  a 
class  by  himself  and  Education  should  take  Nature's  : 
hint.'  It  was  recommended  that  twelve  school  rooms  be 
selected  and  equipped,  not  as  makeshifts,  but  in  the  best 
possible  manner,  with  a  view  to  meeting  a  permanent 
demand. 


THE  PSYCHOLOGICA.L  CLINIC  C9 

"To  meet  the  present  needs  of  the  city  of  St.  Louis  for 
the  education  of  defective  children,  the  Board  ordered 
tliat  three  houses  be  provided  and  they  appropriated 
§12,000  to  cov(T  the  expense  of  the  special  schools  for  the 
remainder  of  the  present  school  year.  A  later  report  sliows 
tiiat  three  special  centres  of  two  classes  each,  organized 
on  the  above-described  plan,  are  now  in  operation  and 
that  each  centre  has  a  waiting  list  of  applicants  for  ad- 
mission." 

The  Number  of  Feeble=minded  in  the  Total  Popula= 
tion. — Besides  these  investigations  in  Baltimore  and  St. 
Louis,  Dr.  Walter  S.  Cornell^  has  made  a  study  of  thir- 
teen schools  in  Philadelphia,  and  with  his  results  also 
gives  facts  and  estimates  made  by  others  as  summed  up 
below. 

"Backward  and  Feeble-minded  Children. — Bearing  in 
mind  that  the  term  backward  children  in  the  definition 
here  adopted  refers  to  those  whose  poor  intellect  is  asso- 
ciated with  suspicious  signs  of  general  mental  defect,  it  is 
seen  at  onc^e  that  this  class  of  children  is  affiliated  more 
closely  with  the  feeble- tninded  than  with  the  dull  group. 
As  these  children  are  on  the  borderland  between  normality 
above  and  abnormality  l^elow,  man}'  assigned  to  the  grou]) 
of  backward  children  by  one  examiner  may  be  designated 
as  feeble-minded  by  another.  To  a  certain  extent  it  is  a 
compromise  class  for  del^atable  cases.  Many  children 
exist,  however,  who  correspond  clearly  to  the  idea  ex- 
pressed in  the  definition.    They  are  tainted  children. 

"Since  the  diagnosis  of  th(\se  cases  rests  more  on  the 
psychical  than  on  th(>  ph3^si(•al  grounds,  and  the  theoretical 

*  Mentally  Defective  Children  in  the  Public  Schools,  Walter  S. 
Cornell,  Psychological  Clinic,  vol.  ii,  No.  3,  Maj'  15,  1908,  pp.  81, 
82,  83. 


70       THE  CONSERVATION  OF  THE  CHILD 

limits  of  the  class  vary  slightly  with  each  examiner, 
the  number  of  backward  children  in  the  schools  is  difficult 
to  determine.  Furthermore,  the  predisposing  influences 
of  race  and  social  condition  combine  to  produce  a  larger 
proportion  of  mental  defectives  in  some  communities 
than  in  others,  and  this  fact  makes  the  value  of  statistical 
studies,  based  on  official  reports,  rather  uncertain. 

"The  following  sources  of  information  on  the  propor- 
tion of  truly  backward  and  feeble-minded  children  are  as 
trustworthy  as  any : 

"1.  The  working  rule  adopted  by  those  officially  in- 
terested, that  one  of  every  five  hundred  of  the  entire  popu- 
lation is  of  feeble  mind.  A  fair  proportion  of  these  find 
their  way  into  the  public  schools. 

"2.  A  report  of  a  London  Commission  several  years 

ago,  stating  that  one  per  cent,  of  the  school  popu- 

inary  of       latiou  is  mentally  defective.     I  have  often  seen 

Statistics 

this  statement,  but  have  not  been  able  to  ascer- 
tain its  trustworthiness. 

"3.  A  very  painstaking  study  by  Miss  Dendy,  of  Man- 
chester, England,^  in  which  expert  examination  of  44,000 
children  showed  280  (over  one-half  per  cent,  in  the  schools) 
to  be  of  feeble  mind.    An  equal  number  of  children  nomi- 

' Of  100,322  children  in  the  public  elementary  schools  of  Man- 
chester, in  1898,  44,463  were  under  the  direction  of  the  School  Board, 
and  were  inspected  to  ascertain  the  proportion  of  those  who  were 
mentally  defective.  The  accuracy  of  these  figures  is  undoubted, 
since  the  case  reports  were  all  passed  upon  by  Dr.  George  Shuttle- 
worth,  and  the  children  were  all  personally  examined  by  Dr.  Ashby, 
a  leading  Manchester  physician.  Five  hundred  and  twenty-five 
cliildren  with  suspected  mental  defect  were  noted  by  the  teachers 
and  by  Miss  Dendy  and  500  of  these  were  examined  by  Dr.  Ashby. 
Of  these  latter  "214  were  dull  and  backward,  276  were  mentally 
feeble,  4  were  deaf  mutes  and  5  did  not  apjicar  sufficiently  behind 
to  come  under  any  of  these  terms."  (From  Report  of  Conference 
of  Women  Workers,  Edinburgh,  1902,  p.  116,  paper  read  by  Miss 
Dendy,  of  Manchester,  England.) 


THE  PSYCHOLOGICAL  CLINIC  71 

nated  for  examination  by  the  teachers  were  diagnosed  by 
the  examiners  as  simply  dull  or  backward. 

"4.  The  existence  in  New  York  City  of  41  special,  un- 
graded classes  for  truly  backward  children,  containing  731 
children  officially  committed  to  these  classes  by  a  medical 
examiner.  These  children  do  not  represent  all  the  pupils 
of  the  New  York  schools,  as  the  report  from  which  these 
figures  are  taken  (New  York  City  Superintendent's  Re- 
port, 1908,  page  628)  covers  only  six  months'  work  of  the 
medical  examiner  in  69  schools.  To  utilize  these  figures 
we  may  assume  these  schools  to  be  the  large  ones  in  the 
proper  districts,  averaging  1200  enrolment,  which  would 
result  in  a  percentage  of  0.9.  The  backward  children 
contain  among  their  number  an  appreciable  proportion  of 
feeble-minded. 

"5.  The  examination  by  the  writer  of  63  truly  backward 
and  12  feeble-minded  children  in  thirteen  Philadelphia 
public  schools  of  10,000  enrolment.  As  all  of  the  pupils 
in  eight  of  these  schools  were  not  systematically  examined 
by  me,  and  as  the  cases  were  referred  to  me  by  teachers, 
the  number  of  backward  children  is  certainly  too  small. 
It  should  be  nearer  80,  which  would  give  a  percentage  of 
0.9.  The  12  feeble-minded  children  doubtless  represent  all 
of  this  class,  so  that  the  proportion  in  this  case  would  be 
0.1  per  cent,  of  the  school  population. 

"In  view  of  these  facts,  it  may  be  asserted  with  fair 
accuracy  that  ten  per  cent,  of  the  public  school  children 
are  dull,  often  from  removable  causes,  0.5  per  cent,  to 
1  per  cent,  are  truly  backward,  and  0.1  per  cent,  actually 
feeble-minded." 

With  these  figures  later  investigations  are  somewhat  at 
variance.  Bulletin  No.  14,  date  1911,  of  the  United  States 
Bureau  of  Education  roughly  estimates  the  number  of 


72       THE  CONSERVATION  OF  THE  CHILD 

"feeble-minded  children"  in  the  public  schools  at  4  per 
cent,  of  the  total  attendance.  It  subdivides  this  4  per 
cent,  into  two  groups.  "The  lower  one  includes  about 
one-half  of  1  per  cent,  of  the  entire  school  membership 
....  They  are  generally  mentally  deficient  .... 
They  are  institution  cases,  and  should  be  removed  to 
institutions. 

"Ranking  just  above  these  are  the  remaining  3.5  per 
cent,  who  are  feeble-minded  but  who  can  be  given  a  cer- 
tain amount  of  training  in  special  classes  in  the  public 
schools."  10 

English  Statisties  on  the  Feeble=minded. — Enormous 
as  the  figures  turn  out  to  be  when  applied  to  the  total 
])opulation  of  America,  they  are  still  conservative  when 
compared  with  the  Royal  Commission  reports  of  1904,  of 
the  British  Isles.  These  statistics  and  the  manner  in 
which  they  were  gathered  and  compiled  are  summarized 
below  from  the  latest  work  on  amentia  by  Dr.  Tregold. 

"In  this  country,  however,  an  enumeration  has  recently 
been  made  on  quite  another  basis.  In  the  year  1904  a 
Royal  Commission  was  appointed  to  consider  the  existing 
methods  of  dealing  with  these  persons,  and  the  Commis- 
sioners decided  that,  before  any  practical  scheme  of  ad- 
ministration could  be  formulated,  it  was  imperative  that 
they  should  obtain  approximately  accurate  information 
as  to  the  number  and  condition  of  the  class.  With  this 
object,  a  series  of  personal  investigations  were  instituted 
on  a  considerable  scale,  and  this  is  the  first  systematic 
attempt  which  has  been  made  to  obtain  reliable  data. 
It  is  not  too  much  to  say  that  these  incjuiric^s  have  added 
enormously  to  our  knowledge  regarding  the  condition, 

I'' United  States  Bureau  of  Education,  Bulletin,  1911,  No.  14; 
Whole  Number  461. 


THE  PSYCHOLOGICAL  CLINIC  73 

manner  of  living,  and  environment  of  the  aments  of  this 
country,  besides  making  it  possible  to  calculate  their 
total  number  with  a  degree  of  accuracy  hitherto  unat- 
tainable. 

"The  method  adopted  by  the  Royal  Commission  con- 
sisted of  a  series  of  elaborate  and  searching  inquiries  by  a 
number  of  medical  men,  to  each  of  whom  a  selected  area 
was  assigned.  The  investigator  was  instructed  to  visit 
personally  all  public  elementary  schools,  poor-law  institu- 
tions, charitable  establishments,  training-homes,  reforma- 
tories, common  lodging-houses,  prisons,  idiot  asylums, 
hospitals,  and,  indeed,  any  establishment  likel}'  to  harbour 
the  mentally  abnormal.  Further,  he  was  to  see  persons  in 
receipt  of  out-door  relief,  to  apply  to  the  clergy,  medical 
practitioners,  the  police,  charity  organization  societies, 
and  similar  agencies,  and,  in  short,  to  make  use  of  any 
and  every  channel  which  might  help  him  to  make  the 
enumeration  comi)lete. 

"It  was  not  found  practicable  to  investigate  the  whole 
of  tlie  country  in  this  way,  but,  in  order  that  conclusions 
applicable  to  the  entire  country  might  be  drawn,  a  selec- 
tion of  certain  typical  areas  was  made.  Altogether,  there 
were  examined  nine  areas  in  England,  two  in  Wales,  one 
in  Scotland,  and  four  in  Ireland,  having  an  aggregate 
population  of  3,873,151." 

It  will  be  seen  from  this  table  that,  while  the  mean 
average  incidence  of  tc^tal  amentia  in  the  six-  The  Per- 
teen  areas  is  3.28  per  1000  population,  the  vari-  <^eBtage 
ation  ranges  from  a  minimum  of  1.1  in  the  case  of  Cork 
to  a  maximum  of  4.G8  in  the  case  of  Lincolnshire.'^ 

"  Mental  Deficiency,  A.  F.  Tredgold,  1908,  pp.  4,  5,  6.  Sec  also 
Rejiort  of  Royal  Coniniission  on  the  Care  and  Control  of  tlie  Feeble- 
minded, London,  li)()S,  vol.  viii,  anil  Feeble-inindcdiiess  in  Children 
of  School-age,  C.  V.  Lapage,  Manchester,  1911. 


74       THE  CONSERVATION  OF  THE  CHILD 

A  Summary  of  American  Conditions. — If  this  esti- 
mate holds  at  all  for  the  United  States — and  there  are 
reasons  for  thinking  that  it  may  be  high  for  this  country — 
it  would  bring  the  total  number  of  mentally  defective 
persons  up  to  something  like  295,000  in  a  population  of 
90,000,000. 

On  the  other  hand,  according  to  the  more  conservative 
estimates,  100,000  to  180,000  defectives  with  irremediable 
nervous  lesions,  rendering  them  unfit  for  social  life  and 
propagation  of  their  kind,  live  in  the  United  States  to-day. 
Of  this  vast  number,  an  estimated  10  per  cent,  are  in  public 
and  private  institutions;  the  other  90  per  cent,  are  pursu- 
ing their  unrestricted  way,  some  at  home,  some  at  work, 
some  as  idlers,  tramps,  loafers,  or  criminals,  and  some  at 
school  clogging  and  diverting  its  energies  from  proper 
channels  in  a  vain  attempt  to  teach  the  uneducable  un- 
teachable  things.  How  many  of  the  total  number  are 
being  deprived  of  any  training  whatever,  and  who  roam 
the  streets  at  will,  no  one  knows.  Certain  it  is  that  every 
hamlet,  every  village,  every  town  and  every  large  city  in 
an  increasing  proportion  has  its  quota  of  children  desig- 
nated as  "foolish,"  "silly,"  "not  all  there,"  "lacking  in 
the  upper  story,"  or  "queer."  Heretofore  these  imfortu- 
nate  ones,  thought  to  be  objects  of  special  visitations  by 
Providence,  and  unable  to  succeed  in  the  public  schools 
by  the  traditional  methods  of  education,  have  been  ac- 
cepted as  burdens  by  their  parents  or  by  the  community, 
and  no  special  effort  made  or  even  thought  of  for  the 
alleviation  of  their  condition.  In  this  wide  and  unfortu- 
nately widening  field  of  mentally  deficient  cases,  the 
Psychological  Clinic  finds  its  special  and  unique  function. 
It  not  only  arouses  the  public  to  interest,  but  instructs 
popular  opinion,  and  by  opening  wide  the  door  of  oppor- 


THE  PSYCHOLOGICAL  CLINIC  75 

tiinity,  permits  and  compels  the  guardians  of  such  chil- 
dren to  take  the  proper  means  of  bringing  them  up  to  the 
full  capacity  of  which  they  are  capable.  In  almost  every 
case  this  is  at  least  to  the  point  of  self-support  in  the  right 
environment,  and  assuredly  in  every  case  the  saving  of 
the  individual  child  and  many  other  members  of  society 
from  untold  suffering. 

Out  of  .such  public  agitation  and  education  must  event- 
ually grow  the  larger  development  of  k^gislation  which 
will  not  only  expand  itself  in  housing,  feeding,  and  train- 
ing imbeciles,  but  will  see  to  it  that  the  community  pro- 
tects itself  from  itself  by  careful  segregation  and  prohi- 
bition of  marriage  among  those  known  to  be  subnormal. 

The  Psychological  Clinic,  then,  like  its  medical  cognates, 
is  a  sociological  institution,  definite  in  its  entity  and  pur- 
pose, but  wide-ranged  in  its  relations  to  other  organiza- 
tions. Its  whole  range  of  affiliations  will  be  more  fully 
treated  in  a  later  chapter.  Its  constitution  or  organization 
will  next  be  taken  up,  and  will  give  a  clearer  conception  of 
its  nature. 


IV. 

OPERATION   OF  THE  CLINIC 

The  operation  of  a  psychological  clinic  is  far  more 
complex  than  the  uninitiated  would  suspect.  In  the  pre- 
ceding chapters  the  reader  has  already  gained  some  no- 
tion of  this  complexity.  In  this  chapter  the  general 
procedure  will  be  outlined  with  the  purpose  of  giving  the 
reader  a  bird's-eye  view  of  the  whole  operation,  to  be 
treated  more  in  detail  in  later  chapters.  Maintaining, 
for  the  sake  of  clearness,  our  emphasis  upon  diagnosis, 
we  wall  inspect  what  the  clinic  does  from  that  point  of  view. 

About  this  central  purpose  all  the  subsidiary  and  depen- 
dent operations  can  be  grouped.  For,  though  the  clinic 
may  be  interested  in  the  administration  of  medical  and 
surgical  treatment,  may  directly  enter  into  almost  all 
phases  of  social  work,  may  supervise  intellectual,  physical 
and  moral  training,  and  perform  the  office  of  guardian, 
friend,  and  foster-parent,  it  assumes  all  these  functions  as 
preliminaries  or  as  necessary  consequences  of  mental 
classification. 

The  Time  Necessary  for  an  Examination. — The 
hours  of  the  clinic  are  made  known  to  the  public  as  widely 
as  possible.  The  sessions  are  held  daily  in  the  afternoon, 
from  two  to  five,  except  Saturdays,  when  the  hours  are 
from  nine  to  eleven  in  the  morning  to  suit  the  convenience 
of  school  children.  All  come  by  previous  appointment, 
and  at  least  one  hour  is  reserved  for  each  examination. 
This  is  frequently  found  to  be  too  short  and  several  subse- 
quent visits  must  be  made  by  the  child  before  the  examina- 
tion can  be  completed  and  full  records  secured.    To  give 

76 


OPERATION  OF  THE  CLINIC  77 

the  requisite  information,  the  father,  mother,  or  some 
other  person  fully  acquainted  with  the  family-history, 
birth,  and  life-history  of  the  child  must  accompany  him. 

The  Reception  of  Cases. — To  the  popular  mind  there 
is  something  repugnant  about  any  clinic.  An  examina- 
tion at  which  the  secret  disposition  of  the  soul  will  be 
revealed  is  still  endued  to  ignorant  minds,  and  even  to 
some  who  in  general  are  far  removed  from  superstition, 
^vith  a  trace  of  that  awe  anciently  attaching  to  charms, 
spells,  or  incantations.  The  modem  psychologist  is  sup- 
posed, like  the  tribal  medicine  man  or  mediaeval  sorcerer, 
to  possess  some  esoteric  power,  some  necromancy  by  which 
he  can  divine  the  condition  of  the  mind. 

Under  these  circumstances,  both  parent  and  child  are 
in  a  more  or  less  disturbed  state  of  mind, — a  condition 
which  peculiarly  frustrates  the  purpose  of  examination. 
The  parents  are  likely  to  be  confused  and  the  child  is 
excited,  whereas  he  should  be  tested  under  the  closest 
possible  approximation  to  his  habitual  temper  and  dis- 
position. 

The  first  duty  of  the  clinician  is  to  overcome  this  state 
of  tension.  At  this  point  the  social  worker  can  be  of 
invaluable  service.  Her  first  pleasant  greeting  of  the 
visitors,  with  some  natural  and  easy  remark, 

•11  r  1      •  /•   •     1  '^^^  Recep- 

will  go  far  to  cure  their  stage-fright  and  put  them  tion  of  the 
into  a  fit  mood  for  the  psychologist.  If  the  first 
good  impression  is  followed  up  by  a  tactful  method  of 
questioning  all  the  information  required  in  ordinary  cases 
may  be  obtained  without  any  great  difficulty  from  more  or 
less  unwilling,  forgetful,  and  ignorant  parents.  Of  course 
when  they  are  extremely  ignorant,  or  unable  to  speak  the 
English  language,  the  elicitation  of  sufficient  trustworthy 
information  about  even  the  simplest  facts  of  life  becomes 


78      THE  CONSERVATION  OF  THE  CHILD 

difficult.  In  no  case,  however,  is  a  blunt  and  belligerent 
manner  justifiable  on  the  part  of  the  examiner,  though  it 
might  be  mistakenly  assumed  on  the  ground  that  the 
examination  is  a  scientific  one  and  therefore  a  plain, 
simple  and  direct  search  for  the  truth.  A  scientist  in 
this  branch  of  investigation  has  every  reason  for  not  omit- 
ting the  amenities  calculated  to  subdue  embarrassment. 
He  is  here  confronted  with  the  task  of  eliciting  vital  in- 
formation from  a  nervous  organism  which  is  ready  to 
react  to  the  slightest  shock;  a  personality,  in  short,  that 
will  respond  most  favorably  to  gentleness,  but  close  up 
like  a  sensitive  plant  when  roughly  handled.  The  astute 
scientist  therefore  will  proceed  to  obtain  his  desired  infor- 
mation with  as  careful  a  method  and  with  as  much 
courtesy  as  if  he  were  dealing  (as  indeed  he  is)  with  Nature 
herself  in  one  of  her  most  taciturn  moods. 

That  such  qualities  are  demanded  of  the  clinician 
should  surprise  no  one.  The  parents  are  laying  bare  the 
tenderest  secrets  of  their  hearts,  their  hidden  fears  and 
unexpressed  hopes.  They  are  thinking  of  the  people  of 
their  neighborhood,  what  they  will  suspect  and  what  they 
will  say,  and  especially  upon  the  possible  stigma  placed 
upon  their  child  by  this  examination.  Such  considerations 
often  cause  parents  to  postpone  a  long  time  their  visit  to  a 
specialist,  and  they  finally  do  come  only  when  circum- 
stances like  backwardness  in  school  bring  a  note  of  sus- 
pension from  the  teacher,  or  when  the  increasing  age  of 
the  child  is  accompanied  with  an  increase  rather  than  a 
decrease  in  the  symptoms  of  the  malady. 

How  to  Handle  the  Child  to  be  Examined. — The 
child  himself  often  has  a  bewildered  dread  of  what  is  to 
happen,  sharing  sympathetically  his  elders'  fears  in  spite 
of  their  assurances  of  his  entire  safety,  and  frequently 


OPERATION  OF  THE  CLINIC  79 

suffering  from  the  nervous  shock  commonly  produced  in 
mentally  defective  children  by  any  change  in  their  sur- 
roundings. These  children  are  always  nervous.  Occa- 
sionally they  come  in  crying,  wringing  their  hands  and 
beseeching  the  "doctor"  not  to  hurt  them.  Sometimes, 
instead  of  fearfulness,  stubbornness  develops  and  a  nega- 
tivism that  defies  all  parental  admonitions  and  all  the 
examiner's  cajoleries.  His  first  task,  therefore,  is  to  place 
himself  immediately  en  rapport  with  all  his  visitors,  to 
set  them  at  ease,  to  radiate  a  careless  geniality  under 
which  is  concealed  a  carefully  prearranged  plan  of  cam- 
paign and  assault  by  well-chosen  questions.  He  will  be 
alert  to  soothe  any  signs  of  fear  or  irritation  on  the  part  of 
the  parents,  to  forestall  any  incipient  stubbornness  on 
the  part  of  the  child,  or  to  follow  up  any  faintest  clue  to  a 
possible  cause  of  deficiency — hereditary,  intra-uterine,  or 
developmental — which  the  parent  may  be  intentionally  or 
ignorantly  concealing. 

The  Number  of  Persons  Present  at  the  Examination. 
— For  these  reasons  also  it  is  highly  necessary  to  limit 
the  number  of  people  in  the  examining  room  to  those 
directly  interested  in  the  work.  Sightseers  and  the  merely 
curious  should  be  rigidly  excluded.  Students  are  admis- 
sible as  assistants  only,  never  as  mere  spectators,  or  with 
note-books.  During  the  examination  the  doors  of  the 
room  should  be  closed  and  no  one  admitted  except  when 
absolutely  necessary.  An  intrusion  will  sometimes  inter- 
rupt a  sequence  of  carefully  plarmed  questioning  or 
destroy  an  interested  attentiveness  that  has  been  obtained 
with  great  difficulty  and  when  once  lost  is  not  to  be  re- 
gained because  of  the  fatigue  or  excitem(>nt  of  the  easily 
affected  child.  For  the  same  reasons  the  furnishings  of 
the  room  should  be  as  simple  as  possible. 


80      THE  CONSERVATION  OF  THE  CHILD 

In  cases  of  mental  deviation,  and  especially  with  a 
small  child,  it  is  permissible  to  examine  it  in  the  presence 

of  the  parents,  but  often  advisable  to  make  at 
Parents'       Icast  a  part  of  the  examination  with  the  child 

alone.  In  cases  of  moral  deviation  the  latter 
method  is  always  necessary,  as  the  accused  child  will  almost 
never  tell  his  side  of  the  story  freely  and  with  full  detail  in 
the  presence  of  his  parents  or  teacher  or  probation  officer. 
All  of  them  have  their  minds  partially  or  fully  made  up 
about  him,  for  it  is*  one  of  the  most  fatuous  delusions  of 
adults  to  believe  that  they  can  easily  divine  the  thoughts 
and  purposes  of  their  charges  in  matters  which  concern 
the  most  unfathomable  mysteries  of  the  human  heart. 
Their  presence,  therefore,  even  when  their  convictions  are 
expressed  in  no  other  way  than  by  silent  approval  or 
disapproval  conveyed  by  looks,  attitude,  and  all  the  other 
minute  signs  of  feeling  to  which  the  subject  is  keenly 
sensitive,  will  act  as  an  effectual  deterrent  to  any  free 
statements  from  the  child. 

To  this  may  be  added  another  reason  why  moral  cases 
should  be  examined  alone.  There  is  always  the  possibility 
that  a  modicum  of  self-respect  may  remain  to  the  bad  boy. 
He  therefore  may  wish  to  maintain  his  reputation  for 
honesty  and  uprightness  in  the  eyes  of  strangers  who  he 
may  assume  know  nothing  of  his  past.  If,  however,  his 
case  is  fully  described  to  the  psychologist  in  his  presence, 
the  last  vestige  of  hope  of  reform  from  this  one  source  is 
gone.  Oftentimes  this  means  much  when  the  psychologist 
is  to  become  his  adviser,  possibly  his  friend,  for  several 
months.  Under  these  circumstances  it  is  advisable  for 
the  examiner  not  only  to  let  the  child  tell  his  own  story, 
but  also  to  conceal  from  the  child  the  extent  of  his  knowl- 
edge derived  from  other  sources.    It  is  well  to  accept  the 


OPERATION  OF  THE  CLINIC  81 

boy's  own  account,  and  reserve  other  information  in  order 
to  check  up  his  statements  concerning  himself  and  to  be 
forearmed  against  any  surprises.  If  it  is  desired  at  any 
time  to  secure  a  full  confession  from  a  boy,  this  should 
never  be  done  with  the  intention  of  humiliating  him,  and 
should  never  result  in  embittering  him.  It  should  be  made 
with  an  idea  that  the  slate  is  to  be  wiped  clean  and  a  new 
start  made. 

Four  Examinations  of  Each  Child  Made. — For  the 
purpose  of  covering  all  details,  the  Psychological  Clinic 
at  the  University  of  Pennsylvania  makes  use  of  four 
examuiations  and  four  reports  for  each  case.  The  first  is  >1 
called  the  general  or  oral  examination;  the  second,  the 
physical;  the  third,  the  mental,  and  the  fourth,  the  social. 
Each  report  is  made  up  in  the  same  general  style,  type- 
written, with  its  appropriate  title  in  the  middle  of  the 
first  line,  the  name  of  the  examiner  underneath;  the  name 
of  the  child,  his  address  and  age,  the  date,  and  a  case 
number  at  the  top. 

The  Oral  Examination. — The  general  examination 
is  made  first  and  begins  immediately  after  the  child  and 
his  parents  or  accompanying  friends  have  entered  the 
examination  room.  It  allows  for  their  possible  confusion 
under  the  ordeal  by  reversing  the  ordinary  chronological 
order  and  by  beginning  with  the  present  and  working 
back  into  the  past.  While  the  details  of  family  history 
and  birth  are  extremely  valuable,  yet  both  are  so  delicate 
and  so  far  removed  from  the  present  situation,  and  to  the 
popular  mind  have  so  little  connection  w'ith  mental 
troubles,  that  the  informer  would  be  unwilling  to  give 
them  freely  and  with  the  accuracy  required,  even  if  he 
could  remember  them.  The  questions,  therefore,  begin 
with  the  present  and  with  the  perfectly  obvious  and 
6 


82       THE  CONSERVATION  OF  THE  CHILD 

natural  request  for  name  and  address  and  the  reason  why 
the  child  was  brought  to  the  clinic.  They  proceed,  lead- 
ing always  away  from  the  present,  through  a  pedagogical 
history  and  statement  of  physical  diseases,  then  gradually 
back  to  babyhood  and  birth,  and  finally  out  into  the 
family  history,  which  is  the  most  difficult  field  in  which  to 
secure  accurate  information  and  yet  one  of  the  most 
important.  For  statistics  indicate  that  at  least  sixty-sLx 
per  cent,  of  idiocy  is  hereditary,  traceable  to  epilepsy, 
insanity,  imbecility  or  other  neuroses  in  the  father  or 
mother  or  grandparents,  while  about  thirty  per  cent,  is  \ 
caused  by  post-natal  injuries  and  diseases,  and  about 
three  per  cent,  by  natal  accidents  or  injuries.  The  ques-  / 
tions  themselves  will  be  studied  more  fully  in  the  next 
chapter. 

The  Physical  Examination. — Immediately  following 
the  general  examination,  including  the  pedagogical  and 
life  histories  of  the  child,  comes  the  physical  examination. 
It  is  performed  by  a  regular  physician  who  volunteers  his 
services  for  this  work,  but  it  is  in  no  sense  a  complete 
medical  diagnosis.  Its  purpose  and  place  in  mental 
diagnosis  will  be  made  clearer  later  on.  At  present  a  few 
general  remarks  about  its  character  will  suffice.  It  is 
extensive  rather  than  intensive;  that  is  to  say,  no  special 
symptoms  or  symptom-complexes  are  looked  for  to  the 
exclusion  of  others. 

The  examination  begins  with  anthropometric  measure- 
ments, and  proceeds  methodically  to  note  every  physical 
defect,  whether  immediately  or  remotely  connected  with 
mental  deficiencies.  The  results  of  the  examination  are 
tabulated  according  to  a  set  form. 

The  physical  examination  is  usually  made  in  a  room 
separate  from  the  regular  clinic  room.    It  is  best  usually, 


Makinji;  head  mcasurcMncnts  in  a  nu'iUal  cxamiuatiou.     Tlic  sliape 
of  the  skvill   is  often  important. 


OPERATION  OF  THE  CLINIC  83 

to  have  as  few  persons  as  possible,  it  being  necessary  to 
remove  much  or  all  of  the  child's  clothing  in  order  to  make 
the  examination.  The  parents  or  others  accompanying 
the  child  should  be  present  only  in  exceptional  cases. 
The  physician,  because  of  his  professional  standing,  can 
secure  admissions  of  moral  lapses  where  no  one  else  can. 
For  the  same  reason,  arrangements  are  made  to  have  the 
girls  examined  by  a  medical  woman  and  the  boys  by  a 
medical  man.  Besides  eliminating  the  natural  embar- 
rassment which  would  defeat  much  of  the  purpose  of  the 
clinic,  the  examiner  must  also  take  care  not  to  frighten 
the  nervous  child  to  such  an  extent  that  he  will  not  sub- 
mit to  later  clinical  examinations  for  the  removal  of  physi- 
cal defects  found  in  this  preliminary  examination. 

The  Mental  Examination  Proper. — After  the  physi- 
cal examination  comes  the  mental  examination  proper. 
It  must  be  remembered  that  the  whole  procedure  is  in  a 
sense  a  mental  test;  that  all  the  previous  inquiries  and 
explorations  into  the  family  history,  the  pedagogical 
career,  the  anatomy  and  physiology  of  the  subject,  have 
been  made  with  a  psychological  motive.  These  underly- 
ing reasons  and  the  ends  which  they  serve  will  appear 
more  clearly  in  a  later  place. 

By  General  Observation. — The  mental  tests  begin 
with  the  examiner's  first  sight  of  the  child,  of  his  general 
reaction  to  the  new  environment,  his  coordination  exhib- 
ited in  standing,  walking,  sitting,  taking  off  his  coat  and 
hat;  his  words,  sentences,  articulation,  sense,  reason, 
general  knowledge  and  mental  grasp,  as  exhibited  in 
talking,  his  attention  to  articles  in  the  room,  his  apathy, 
indifference,  dulness,  stupidity,  excitability,  alertness, 
irritability,  his  attitude  toward  mother  or  father,  everj'- 
movement  he  makes,  everj^  flitting  expression  on  his  face, 


84       THE  CONSERVATION  OF  THE  CHILD 

— all  are  caught  by  the  tramed  observer  and  rapidly 
built  up  into  a  picture  to  be  compared  with  the  other 
clinical  pictures  already  in  his  mind.  Such  skill  comes 
only  by  practice;  no  tests  can  ever  satisfactorily  take 
its  place. 

Reference  has  already  been  made  to  the  alertness  of 
the  examiner  to  forestall  either  stubbornness  or  undue 
excitement.  To  this  ability  he  must  further  constantly 
add  an  accurate  judgment  of  the  conditions  which  now 
tend  to  affect  the  child.  He  must  make  allowance  for 
fatigue,  excitement  of  affected  nerves,  and  all  the  other 
influences  that  are  working  in  the  defective  mind  of  the 
child  under  the  new  circumstances.  The  nicety  of  this 
allowance  is  a  large  factor  in  the  final  determination  of 
the  child's  mentality,  and  sometimes,  in  the  case  of  border- 
land children,  is  absolutely  decisive  in  placing  the  child  in 
one  class  or  another. 

In  this  mental  examination  by  general  observation  the 
mother  (or  other  relative)  of  the  child  must  be  included. 
The  relations  existing  between  her  and  her  offspring,  as 
shown  by  a  child's  attitude  toward  the  mother,  are  of  high 
importance.  One  of  the  almost  immediate  signs  of  feeble- 
mindedness on  the  part  of  the  child  is  his  constant 
turning  to  the  parent  for  a  cue  whenever  a  question  is 
put  to  him.  The  answering  attitude  of  the  mother  will 
immediately  indicate  her  unexpressed  and  perhaps  un- 
conscious estimate  of  the  child.  Upon  these  peculiar, 
yet  almost  unnoticeable  indications  hinges  much  of  the 
classification. 

Besides  these  furtive  and  flitting  indicatory  expressions, 
the  mother  herself  presents  an  object  of  interesting  obser- 
vation to  the  examiner.  The  clothing  she  wears,  her 
deportment,  manners,  and  general  behavior,  all  tell  some- 


OPERATION  OF  THE  CLINIC  85 

thing  of  her  social  station,  and  consequently  something  of 
the  surroundings  of  the  child.  In  her  deportment  she 
will  exhibit  signs  of  her  own  mentality,  oftentimes  reveal- 
ing a  high-strung  nervous  temperament  or  an  apathetic 
dulness  closely  allied  to  the  condition  of  her  child. 

Sometimes,  indeed,  the  mother  is  patently  feeble- 
minded herself,  but  to  say  such  a  thing,  or  to  even  liint 
such  a  thing,  would  immediately  bring  on  a  The 

storm  of  indignation.  Oftentimes,  however, 
such  a  mother  can  be  led  to  talk  of  her  own  ills  and  thus 
unintentionally  reveal  some  information  which  connects 
her  neurotic  tendencies  by  heredity  with  the  imbecility 
of  the  child.  All  that  has  been  said  about  the  mother  can 
be  said  equally  about  the  father  if  he  be  present,  and  to  a 
lesser  degree  about  the  relatives  who  may  come.  It  is 
well,  therefore,  to  secure  the  attendance  at  the  clinic  of 
as  many  of  the  family  as  possible. 

It  might  be  remarked  in  passing,  that  one  of  the  chief 
difficulties  in  dealing  with  mentally  defective  cases  is 
found  hi  the  parents  themselves.  They  are  almost  always 
ignorant  or  inefficient.  The  inefficient  are  either  weak  or 
over-hard  in  their  discipline  of  the  child.  To  secure  a 
sane  and  sensible  treatment  with  a  modicum  of  the  dis- 
cipline necessary  with  all  mental  defectives,  and  yet  to 
restrain  the  impatience, — sometimes  the  passion, — of  the 
parent  in  the  administration  of  discipline,  is  an  exceed- 
ingly difficult  problem,  so  difficult  that  one  of  the 
fundamental  principles  of  training  such  children  is  to 
remove  them  first  from  the  immediate  supervision  of 
their  parents. 

Along  these  general  observations,  statements  concern- 
ing the  play  of  the  child,  his  ordinary  likes  and  dislikes, 
his  general  behavior,  especially  in  the  company  of  other 


86       THE  CONSERVATION  OF  THE  CHILD 

children,  are  of  prime  importance.  If  he  plays  regularly 
and  persistently  with  children  younger  than  himself,  it  is 
an  almost  conclusive  sign  of  mental  feebleness,  and  the 
age  of  the  children  with  whom  he  plays,  to  some  extent  at 
least,  will  mark  the  degree  of  his  deficiency.  The  kind  of 
play  that  he  likes  is  also  significant.  If  a  boy  spends  his 
time  playing  with  tools,  endeavoring  to  make  wagons  or 
kites,  or  other  toys,  but  has  no  inclination  for  books,  and 
is  unable  to  learn  to  read,  he  exhibits  the  signs  of  one  class 
of  imbeciles.  If  his  parents,  after  confessing  their  child's 
inability  to  study  properly  and  to  advance  in  school,  at 
the  same  time  express  their  pleased  amazement  at  his 
wonderful  musical  ability,  his  talent  for  quickly  catching 
and  carrying  a  tune  or  popular  air,  another  sign  of  imbe- 
cility will  appear  to  the  expert  examiner.  If,  added  to 
this,  he  likewise  boasts  of  a  good  memory  for  odds  and 
ends  without  logical  connection,  the  conclusion  is  almost 
inevitable  that  feeble-mindedness  is  present. 

Particular  Mental  Tests. — To  this  method,  by  general 
observation  of  every-day  and  ordinary  expressions  of  con- 
duct, the  examination  by  mental  tests  must  be  added. 
This  matter  will  be  taken  up  in  detail  in  the  next  chap- 
ter. A  cursory  glance  will,  however,  be  given  here  at  the 
general  method  and  kinds  of  tests  used. 

This  part  of  the  examination  comprises  a  series  of  ques- 
tions and  tests  concerning  the  child's  temperament  and 
mentality.  Spelling  words  and  problems  and  reading 
selections  corresponding  to  the  various  school  grades  are 
used.  This  gives  an  easy  and  accurate  standard  for  meas- 
uring the  child's  present  pedagogical  status,  as  well  as  the 
extent  of  his  retardation.  Tests  in  reading  are  given  in 
selections  from  the  regular  school  readers  for  each  grade, 
upon  the  same  paper  and  in  the  same  print  commonly 


OPERATION  OF  THE  CLINIC  87 

used  in  the  public  schools.  The  form-board  test  for  idea- 
tion processes,  the  color  tests  for  perception,  selection 
tests  for  memory  span,  tests  for  association  between  audi- 
tory and  visual  stimuli,  coordination  tests,  and  in  the 
case  of  necessity  all  the  finer  laboratory  tests  for  reaction 
time  and  association  time  are  given. 

Simple  Tests. — The  best  and  simplest  tests  are  the 
ones  most  like  the  natural  reaction  of  the  child  toward 
common  objects.  Instead,  however,  of  trusting  him  to 
react  spontaneously  or  accidentally,  several  typical 
objects  are  used  to  prompt  his  reactions.  For  example, 
as  coordination  can  be  tested  by  throwing  a  ball,  by  plac- 
ing pegs  in  a  peg-board,  by  replacing  blocks  in  a  form- 
board,  or  the  handling  of  certain  kinds  of  to3's,  the  ac- 
curacy of  his  perceptions  may  be  tested  with  simple 
colored  blocks,  colored  yarns  and  other  objects.  With 
the  same  materials  the  memory  span  may  be  also  measured 
accurately  enough  for  ordinary  clinical  work.  For  instance, 
three  or  four  blocks  of  different  colors  may  be  held  in  the 
examiner's  hand  before  the  eyes  of  the  child  for  an  instant 
and  then  put  out  of  sight.  Then  the  child  is  required  to 
choose  the  same  blocks  from  a  neighboring  pile.  The 
number  of  the  blocks  may  be  varied  from  experiment  to 
experiment,  until  the  number  becomes  too  largo  for  the 
child  to  grasp  in  one  instant.  Usually  this  number  is  four 
or  five.  With  some  little  ingenuity  and  comparatively 
few  toys  the  expert  examiner  can  develop  an  almost  end- 
less variety  of  tests  for  mentality;  and  since  the  real  test 
of  anyone's  mentality  is  his  reaction  under  normal  con- 
ditions and  the  nearest  approach  to  normal  conditions  is 
the  play  life  of  the  child,  these  tests  are  not  exceeded  in 
value  by  any  others  for  giving  a  general  estimate  of  a 
child's  mental  capacity. 


88       THE  CONSERVATION  OF  THE  CHILD 

Laboratory  Tests. — If  by  this  time  sufficient  causes 
for  backwardness  have  not  been  revealed,  further  and  more 
accurate  tests  are  made  with  the  apparatus  in  the  labora- 
tory. For  example,  the  excitability  of  his  nervous  system 
may  be  tested  by  the  length  of  the  patellar  reflex  kick  or 
of  the  reaction  time;  his  blood  pressure  may  be  taken; 
the  reaction  of  his  vasomotor  system  to  certain  mental 
conditions  may  be  accurately  measured  by  the  plethysmo- 
graph  or  the  algometer;  audiometer  and  ergometer  tests 
may  be  made.  These  indicate  the  present  physical  and 
mental  condition  of  the  child,  his  power  to  react  quickly 
and  accurately  to  new  stimuli  and,  in  the  case  of  repeti- 
tion, his  power  to  adjust  himself  to  a  new  environment 
and  learn  by  that  repetition.  By  this  time  a  very  fair 
estimate  of  the  condition  of  the  child  can  be  made.^ 

The  Social  Examination  and  Report. — At  the  end  of 
the  examination  the  child  is  again  handed  over  to  the 
social  worker,  who  makes  arrangements  for  visits  to  other 
clinics,  or  to  physicians  and  spec  alists  who  will  diagnose 
physical  defects,  perform  surgical  operations,  or  adminis- 
ter medical  treatment.  Sometimes  the  social  worker  will 
follow  the  child  into  a  home  and  there  supervise  the  ad- 
ministration of  medical  treatment  under  the  advice  of 
the  physician.  Oftentimes,  too,  her  personal  influence 
over  a  recalcitrant  child  may  smooth  out  a  great  many 
difficulties.  Exactly  what  she  does  and  how  she  does  it 
are  more  accurately  set  forth  in  a  number  of  concrete  illus- 
trations scattered  through  this  book. 

Her  work  in  the  home  naturally  leads  to  the  second 
portion  of  her  duties,  i.e.,  the  making  of  reports  upon 

^For  a  complete  account  of  various  tests  for  mental  capacity 
Bee  "Manual  of  Mental  and  Physical  Tests,"  by  Guy  Montrose 
Whipple.    Warwick  &  York,  Baltimore,  1910,  p.  534. 


A  child  liciiifi  testcil  for  individuiil  caiKicilics.     Sdiiic  of  tliis  aj))):!- 
ratus  is  like  that  u.sed  !)V  Madame  Moutessori. 


OPERATION  OF  THE  CLINIC  89 

those  phases  of  home  life  or  environment  which  affect 
mentality  and  may  assist  in  the  classification  of  the  case,^ 

Eventually  she  is  the  one  who  assists  the  parents  in 
secur'ng  admission  to  the  proper  institutions  for  the  per- 
manent training  of  mentally  defective  children.  The 
parents  themselves  are  often  lamentably  ignorant  of  how 
to  proceed  to  secure  relief  for  their  afflicted  child  and  when 
the  way  is  pointed  out  to  them  often  need  the  constant 
inspiration  and  prodding  of  some  one  who  is  familiar  with 
the  details,  and  who  understands  the  importance  of  the 
project.  They  require  an  immense  amount  of  sympathy, 
of  patience  and  tactful  management  in  order  to  do  their 
duty  by  their  children  and  by  society. 

The  work  of  .securing  admission  to  institutions  for  chil- 
dren necessarily  involves  a  wide  and  thorough  study  of  all 
public  and  private  institutions  for  such  children.  The 
social  worker's  duties  include  the  constant  securing  of 
information  through  circulars,  catalogues,  and  reports  of 
such  organizations,  for  future  reference.  On  the  other 
hand,  since  many  children  come  from  charitable  organiza- 
tions and  are  returned  to  charitable  organizations,  it  is 
necessary  for  her  also  to  be  aware  of  the  number,  organiza- 
tion, location,  purpose  and  methods  of  such  societies.  In 
these  few  suggestive  words,  some  idea  of  the  great  possi- 
bilities and  the  large  field  of  the  social  worker  in  connec- 
tion with  the  psychological  clinic  are  indicated,  although 
much  must  be  left  to  the  imagination  of  the  reader. 

The  Work  of  the  Recorder. — This  chapter  would  not 
be  complete  without  mention  of  the  recorder  Avho  is  pres-  , 

ent  at  every  examination,  and  who  takes  all  the  notes         N. 
concerning  each  case.     She  must  be  a  stenographer  of 
ability  and  at  the  same  time  possess  the  personality  and 
tact  demanded  of  every  one  who  undertakes  any  part  of 


90       THE  CONSERVATION  OF  THE  CHILD 

this  work.  It  is  impossible  for  the  examiner  to  ask  a 
question  and  dictate  the  answer  to  the  recorder.  She 
must  be  able  by  experience  to  learn  what  portions  of  the 
answer  are  essential  and  what  portions  are  trivial  and  of 
no  value  to  the  classification.  While  she  must  always  be 
present,  she  must  never  be  in  evidence;  for  nothing  will 
interfere  with  the  free  exploitation  of  the  case  like  the 
sight  of  someone  taking  notes  of  everything  thus  answered. 
In  many  examinations  it  is  necessary  to  stop  and  explain 
to  the  suspicious  visitor  that  the  notes  taken  are  for  the 
perusal  of  the  examining  psychologist  and  are  not  to  be 
made  public. 

When  the  notes  are  taken  and  typewritten,  it  falls  to 
the  recorder  to  file  them  in  the  proper  filing  cases  for 
future  reference.  For  this  purpose,  possibly  the  best 
method  is  to  write  the  notes  upon  paper  of  the  ordinary 
size,  8  x  lOYi,  with  marginal  headings  for  easy  reference,  to 
file  them  with  all  other  material  pertaining  to  the  case  in 
an  ordinary  manilla  folder,  upon  the  edge  of  which  are 
placed  the  number  of  the  case,  the  name  of  the  child,  and 
the  date  of  examination.  Such  a  method  permits  of  ready 
reference  and  almost  unlimited  expansion. 

We  have  now  followed  the  child  through  the  various 
operations  of  a  clinical  examination  and  given  some  hint 
of  subsequent  medical  treatment  and  pedagogical  train- 
ing. The  space  here  devoted  to  the  discussion  of  training 
is  in  no  wise  commensurate  with  the  vast  practical  impor- 
tance of  such  work.  In  the  one  function  of  classification 
the  clinic  is  supreme,  and  there  it  finds  its  particular  and 
peculiar  field.  It  is  an  open  door  of  opportunity  for  every 
parent,  guardian  or  teacher  on  whom  the  responsibility 
of  a  backward  child  devolves  to  have  a  mental  classifica- 
tion quickly  and  certainly  made.    The  importance  of  an 


A  steadiness  test.  The  ohiltl  must  hit  the  centro  of  a  tai^iet  with 
a  metal  point.  If  he  does  hit  it  an  ek'etric  b(>ll  rings.  The  targets 
decrease  in  size. 


A  te.'it  of  a  ehi 


ahihty  to  form  a  picture  of,  or  to  recognize  a 
shape  by  touch. 


OPERATION  OF  THE  CLINIC  91 

early  classification,  with  the  consequent  advice  concern- 
ing training,  has  been  amply  emphasized  in  the  preceding 
pages. 

The  psychological  clinic,  while  performing  this  neces- 
sary and  peculiar  service  to  the  community,  still  in  no 
way  seeks  to  usurp  the  functions  of  any  other  social 
service  organization,  or  in  any  way  to  encroach  upon 
fields  already  occupied. 


V. 

THE  CLASSIFICATION   OF  CLINIC   CASES 

The  preceding  chapter  has  made  it  manifest  in  what 
sense  the  central  operation  of  the  Psychological  Clinic  is 
mental  classification.  To  make  as  clear  as  possible  what 
is  meant  by  classification  is  the  business  of  this  chapter; 
and  no  mean  nor  light  task  it  is.  For,  of  all  the  compara- 
tively simple  and  objective  operations  of  mental  therapeu- 
tics, this  one  of  classification  has  shrouded  itself  in  a 
singular  penumbra  of  confused  definitions  and  cross  classi- 
fications, so  that  the  most  skilful  diagnosticians  and  the 
most  expert  writers  on  the  subject  are  not  agreed  upon 
the  meaning  and  implications  of  this  process  so  funda- 
mental to  the  whole  problem  of  backwardness,  mental 
deficiency  and  moral  delinquenc3\ 

How  Confusion  among  Proposed  Systems  of  Classi- 
fication Affects  the  Children  Classified. — Fortunately, 
the  results  of  this  confusion  concerning  definition  are 
confined  chiefly  to  academic  discussion  and  do  not  affect 
the  personal  feelings  of  the  subject  classified,  who  is 
usually  about  as  indifferent  to  the  artificial  classification 
imposed  upon  him  as  the  average  normal  man  is  indiffer- 
ent to  the  estimate  of  his  essential  worth  imposed  upon 
him  by  accidents  of  birth  or  fortune.  Only  occasionally 
does  a  feeble-minded  person  arise  to  the  comprehension 
of  the  meaning  attached  to  his  gradation  and  partially 
to  resent  it  as  did  one  imbecile  who  bribed  an  attendant 
at  an  exhibition  to  remove  a  card  from  his  piece  of  manual 
work  and  substitute  another  card  crediting  him,  not  with 

92 


CLASSIFICATION  OF  CLINIC  CASES        93 

normal  mentality, — which,  to  him,  would  possess  no  dis- 
tinction,— but  with  imbecility  one  grade  higher! 

Beyond  his  own  personal  estimate  of  himself,  however, 
the  subject  may  be  materially  affected  by  the  judgment 
emanating  from  experts.  Their  decisions  as  to  his  mental 
capacity  under  the  traditions  and  popular  usages  growTi 
up  about  such  ancient  phenomena  as  mental  aberrations 
in  all  forms  will  inevitably  have  some  effect  upon  the 
deliberate  treatment  accorded  to  the  child  by  his  guar- 
dians and  upon  the  unreflective  attitude  of  society  toward 
him.  These  effects  will  be  more  clearly  elucidated  fur- 
ther on.  Just  now  we  are  concerned  w4th  clarifying  the 
notion  of  classification  and  what  is  involved  in  it. 

The  Twofold  Aspect  of  Mental  Diagnosis. — We  can 
simplify  our  proljlem  much  bj'  remembering  that  all 
diagnoses  comprise  two  parts:  first,  the  process  of  recogniz- 
ing a  disease  from  its  symptoms  and  deciding  as  to  its 
character,  and  second,  the  result  of  that  decision.  The 
result  of  a  mental  diagnosis  is  the  assignment  of  the 
subject  to  a  class.  Hence,  mental  classification  appears 
to  be  a  more  appropriate  term  than  diagnosis,  though  the 
latter  is  so  widely  used  as  to  make  a  change  inadvisable. 
The  process  might  be  called  a  mental  analysis,  though  the 
matter  of  names  is  of  secondary  importance  if  we  keep 
clearly  before  our  minds  these  two  questions:  What  are 
we  seeking  in  mental  diagnosis?  and,  How  do  we  seek  it? 
The  answer  to  the  first  is:  To  place  the  subject  in  a  class 
already  decided  upon,  and  to  the  second:  By  discovering 
some  mark  or  sign  which  will  decide  to  what  class  he  be- 
longs. To  do  this  proporlj'  requires  first  to  devise  a  scheme 
of  classification  and  then  to  determine  the  method  of 
assigning  any  particular  subject  to  his  class.  The  latter 
process  will  be  fully  treated  in  a  later  chapter.    Just  now 


94       THE  CONSERVATION  OF  THE  CHILD 

we  will  occupy  ourselves  with  the  scheme  of  classification. 
It  ought  to  be  kept  in  mind  always  that  no  classifications 
appear  in  nature;  that  all  individuals  differ  from  others, 
and  yet  each  individual  is  like  others.  In  classifying 
individuals  we  are  dividing  them  into  groups  which  rep- 
resent types,  and  the  individuals  assigned  to  these  groups 
all  differ  more  or  less  from  the  average  or  typical  of  the 
group.  Classifications  are  made  for  convenic^nce;  for  the 
sake  of  easily  dealing  with  large  numbers  of  individuals 
by  reducing  them,  in  a  sense,  to  a  fewer  number  in  which 
the  class  standa  for  the  unit. 

The  First  Step  Toward  Classification. — First  of  all, 
it  is  to  be  noted  that  those  who  come  to  the  clinic  are 
already  partially  classified.  Something  in  their  character 
or  conduct  has  led  those  who  have  them  in  charge  to  select 
them  out,  and  to  bring  them  for  a  further  and  more  scien- 
tific examination.  The  reasons  of  their  selection  are 
manifold.  All  can  be  summed  up  under  the  two  heads  of 
"mental  deviation"  and  "moral  deviation."  We  adopt 
the  term  "deviation"  here  because  it  is  the  broadest  and 
most  inclusive  one  that  can  be  applied  to  those  who  come 
to  the  clinic.  It  denotes  a  great  class,  but  connotes  one 
attribute  only,  viz.,  that  of  difference  or  diversity.  The 
child  who  is  brought  is  not  normal,  or  usual,  or  typical. 
That  means,  in  general,  that  he  is  different  from  others  and 
may  be  different  in  many  ways.  He  may  be  abnormal, 
subnormal,  retarded  or  advanced,  physically  or  mentally 
defective,  deliberately  bad,  or  a  victim  of  bad  environ- 
ment, or  a  host  of  other  alternatives, — in  short,  anything 
that  deviates  from  the  mental  norm. 

The  Principle  of  Classifying  Deviates. — Waiving, for 
the  time  being,  the  difficulties  attached  to  the  definition 
of  normal,  which  we  can  fairly  do  because  the  mere  fact 


CLASSIFICATION  OF  CLINIC  CASES         95 

that  a  child  is  brought  to  the  clinic  argues  that  it  has 
deviated  more  or  less  from  the  vague  standard  of  nor- 
mality existing  in  the  community  from  which  it  comes,  we 
will  turn  again  to  search  for  some  practical  and,  as  far  as 
possible,  definite,  clear  and  universal  principle  of  classifi- 
cation of  these  cases.  That  is  our  first  step  in  a  clinic- 
classification  after  the  child  has  arrived  at  the  examina- 
tion room  and  after  he  has  already  been  classified  by  soci- 
ety as  a  deviate.  Of  course  a  few  normal  children  are 
brought  through  mistaken  or  over-anxious  parents,  but 
they  are  not  properly  clinic  cases. 

Curable  and  Incurable  Deviates. — A  beginning  can 
be  made  by  answering  the  question  on  the  lips  of  every 
visitor  to  the  clinic,  "Can  my  child  be  cured?"  This 
mquiry  every  mental  classification  must  meet,  and  the 
answer  will  immediately  assign  the  child  under  examina- 
tion to  one  or  two  great  categories.  He  is  either  curable 
or  he  is  not.  All  the  cases  of  mental  deviation,  no  matter 
what,  nor  how  remote  may  be  their  causes,  nor  into  what 
wilderness  of  complexity  their  symptoms  may  run,  are 
either  curable  or  incurable. 

The  reader  must  be  immediately  warned  against  accept- 
ing this  classification  as  an  all-embracmg  catalogue  of  all 
present  and  all  possible  children.  It  is  not.  First,  it  is 
primarily  a  mental  and  moral  classification.  That  is,  it 
considers  the  minds  and  the  morals  of  the  children  when 
it  places  them  in  one  category  or  the  other.  It  attends  only 
secondarily  to  hereditarj'-,  environmental, anatomical,  phys- 
iological and  pathological  factors,  no  matter  how  large  these 
items  may  loom  in  the  actual  examinations.  They  are 
and  must  be  considered,  but  they  are  not  here  selected  as 
the  prime  aspects  or  marks  for  classifying  children. 

A  number  of  fuller  classifications  have  been  made  from 


96       THE  CONSERVATION  OF  THE  CHILD 

different  viewpoints  and  for  special  purposes.  Dr.  Bruner^ 
mentions  at  least  four  viewpoints:  the  etiological,  the 
anatomical,  the  symptomatological,  and  the  psychological. 
Dr.  Witmer^  proposes  a  three-fold  scheme  based  upon  the 
possibility  of  instructing  exceptional  children  in  public 
schools.  Dr.  Groszmann^  has  presented  one  of  the  most 
comprehensive  schemes  for  classifying  all  children  into 
normal,  subnormal  and  abnormal  groups  chiefly  by  their 
social  efficiency.  Many  others  made  by  psychiatrists 
and  medical  writers  on  mental  diseases  might  be  quoted, 
but  these  mentioned  are  more  directly  connected  with  our 
field  and  are  sufficient  to  illustrate  our  point. 

Next,  the  classification  is  merely  descriptive.  As  far  as 
possible  we  have  purposely  excluded  from  it  all  reference 
to  explanations  or  causes.  To  say  that  Johnny  is  "  curably 
backward"  does  not  necessarily  or  a  priori  attach  his 
backwardness  to  any  one  cause  or  causes.  It  may  be 
known  from  experience,  even  with  scientific  certainty, 
that  certain  physical  conditions  are  associated  always 
with  incurable  retardation.  Such  correlations  in  the 
future  may  increase  or  decrease  in  number,  but  this  will 
in  no  wise  affect  the  application  of  our  principle.  Granted 
that  future  developments  may  place  much  more  emphasis 
than  now  upon  the  symptom-complexes,  clinical  pictures, 
and  lack  of  particular  mental  capabilities,  as  decisive  for 
naming  varieties  of  mental  diseases,  still,  not  a  future  case 
will  ever  arise  regarding  which  the  fundamental  question 
here  proposed  may  not  be  asked  and  still  retain  its  sig- 

1  Proceedings  of  the  National  Educational  Association,  1909, 
Abnormal  Children,  Frank  G.  Bruner. 

2  Bureau  of  Education,  Bulletin,  1911,  No.  14,  Whole  No.  461, 
pp.  21,  22. 

'  Report  National  Association  for  the  Study  and  Education  of 
Exceptional  Children,  1911,  pp.  6,  7. 


CLASSIFICATION  OF  C  LINIC  CASES         97 

nificanee.  Whatever  may  be  the  correlates,  causes  or 
occasions  of  any  mental  deviation  presented,  whether 
lodged  in  an  uttermost  ancestral  taint  or  an  immediate 
cerebral  lesion,  and  however  difficult  in  practice  it  may  be 
to  apply  this  principle,  in  theory  at  least  it  makes  the 
problem  of  mental  classification  thoroughly  definite. 

Remember,  too,  it  is  a  clinic-classification.  It  is  born  out 
of  the  needs  of  clinic-operation  and  shaped  by  the  exigen- 
cies of  practical  service.  It  has  its  limitations.  Since 
normal  children  are  not  usually  brought  to  clinics  it  does 
not  include  "normality"  as  one  of  its  categories.  Since 
chiefly  bad  or  backward  children  find  their  way  to  mental 
clinics  our  treatment  of  the  subject  emphasizes  those  classes, 
though  they  are  not  primary  in  the  classification.  Since 
the  clinic  is  an  ameliorative  or  curative  institution,  and 
the  former  function  is  necessary  to  the  latter,  we  have 
stressed  the  prognosis  of  the  cases  and  made  it  a  funda- 
mental principle  of  classification. 

It  must  be  remembered  that  we  are  not  here  endeavoring  to 
frame  a  logical  definition  of  mental  deficiency  in  its  genuses, 
species  and  varieties.  Our  task  is  to  furnish  such  a  clear 
and  practical  scheme  of  classification  for  those  varieties 
of  mental  deviation  met  with  m  the  ordinary  course  of 
practice  in  a  psychological  clinic  that  the  children  can  be 
quickly  classified  for  proper  remedial  or  ameliorative 
measures.  The  salutary  end  of  the  clinic-operation  must 
always  be  kept  in  the  forefront.  In  the  light  of  this  end 
theoretical  refinements  may  be  waived  in  favor  of  work- 
able definition  and  lucid  classification. 

Finally,  many  objections  may  remain  against  this  mode  of 

classifying  clinic  cases.    At  first  sight,  it  seems  to  partake 

more  of   a  logical  necessity  than  a  feasible  and   fertile 

characterization    of    real    children.     We   can  only   reply 

7 


98       THE  CONSERVATION  OF  THE  CHILD 

that  it  has  already  been  used  in  our  clinic  practice  and  has 
been  found  to  have  a  vital  significance.  Upon  the  cura- 
bility or  incurability  of  a  case,  as  we  shall  see  later,  depend 
its  medical,  surgical,  pedagogical  treatments  and  its  ulti- 
mate disposition  in  society.  Further,  so  vital  is  this  dis- 
tinction that  the  majority  of  specialists  on  feeble-minded- 
ness  make  this  the  essential  mark  of  real  amentia.  Dr. 
Tredgold  says  *...."  The  essence  of  mental  defect  is  that 
it  is  incurable,  and  by  no  'special'  education,  however 
elaborate,  can  a  case  of  amentia  be  raised  to  the  normal 
standard.  Some  defect  must  always  remain,  and  upon 
this  fact  all  authorities  agree." 

A  Mental  Diagnosis  is  Essentially  a  Prognosis. — It 
will  be  noted  that  the  adoption  of  curability  and  incura- 
bility as  bases  for  classification  fixes  at  once  the  nature  of 
the  diagnosis.  It  is  no  longer  a  simple  and  comparatively 
easy  observation  of  the  present  condition  of  a  child  and  an 
immediate  judgment  based  thereon  concerning  his  present 
mental  condition.  Any  common  public  school  examina- 
tion will  tell  what  a  child  knows  now.  What  the  child 
now  knows  is  an  indication  of  its  mentality,  but  not  a 
final  one.  What  it  will  learn  or  can  know  under  certain 
conditions  and  with  proper  methods  of  training  is  the  all- 
important  and  decisive  question.  Therefore,  it  may  hap- 
pen that  of  two  children  of  the  same  age,  one  may  show 
marked  superiority  in  intellectual  attainments  as  measured 
by  public  school  standards  and  yet  be  judged  an  imbecile; 
while  the  other  is  considered  normal.  The  unlearned  child, 
either  through  neglect  or  on  account  of  removable  physi- 
cal defects,  has  had  no  training,  the  other  has.  The  classi- 
fication predicts  that  the  latter  can  learn  only  so  much, 

*  Mental  Deficiency,  A.  F.  Tredgold,  p.  127. 


CLASSIFICATION  OF  CLINIC  CASES         99 

will  then  reach  his  full  mental  capacity,  and  from  that 
time  remain  stationary  or  recede  from  his  best  attainment. 
On  the  other  hand,  the  capacity  of  the  normal  child  is  an 
unpredictable  quantity  or  quality  and  its  progress  has  no 
present  assignable  limits.  This  view  of  diagnosis  agrees, 
too,  with  the  general  though  little-thought-of  truth  that 
all  children  are  bom  idiots,  deaf,  dumb  and  blind,  and  that 
in  their  growth  they  pass  through  all  the  stages  of  idiocy, 
imbecility  and  moronity  to  the  normal.  Binet,  as  we  shall 
see  later,  bases  his  system  of  mental  tests  upon  this  fact 
and  measures  mental  deficiency  in  terms  of  the  normal 
child's  progress  at  certain  ages.  With  this  view,  too.  Dr. 
Bruner,  an  educator,  agrees  perfectly  when  he  says:  "But 
no  matter  how  elaborate  and  inclusive  the  mental  analysis 
which  a  diagnostician  may  make,  it  is  not  how  the  mind 
habitually  or  overtly  functions  which  must  form  the 
criterion  as  to  a  child's  place  in  the  intellectual  scale,  but 
his  possibilities  for  improvement  under  training,  and  hence 
his  future  promise  of  social  adaptability  and  service."^ 

What  the  Mental  Clinicist  Must  Measure. — A  sharp 
distinction,  therefore,  must  be  made  between  the  child's 
present  attainments, — whether  this  concerns  reading, 
arithmetic,  \ATiting,  or  playing, — and  his  mental  capacity. 
It  is  the  latter  and  not  the  former  that  is  the  essential 
quality  to  be  measured  by  the  examiner.  But  here  again 
a  further  distinction  must  be  carefully  kept  in  mind. 
Some  have  been  inclined  to  make  determination  of  the 
present  mental  capacity  of  the  child  the  sole  quest  of  then- 
search.  Such  a  view  is  expressed  by  Binet  in  the  following 
words:    "It  is  intended  that  these  diagnoses  are  of  value 

*  Abnormal  Children,  Their  Classification  and  Instruction,  Dr. 
F.  G.  Bruner,  Proceedings  of  the  National  Education  Association, 
Denver,  Colo.,  July  3,  1909. 


100     THE  CONSERVATION  OF  THE  CHILD 

only  for  the  present  moment.  He  who  is  imbecile  to-day- 
can  perhaps  become  feeble-minded  as  he  grows  older,  or, 
on  the  contrary,  remain  an  imbecile  all  his  life.  One  can- 
not tell,  the  prognosis  is  reversed."*  Manifestly  such  a 
The  theory  makes  a  diagnosis  valuable  only  to  the 

Measures  extent  that  the  theory  is  untrue.  If  the  state- 
Potentiais  jjjg^^  abovc  is  to  be  taken  literally  the  diagnosis 
is  of  no  avail  the  next  moment.  Its  value  increases  in- 
versely to  the  truth  of  the  theory.  Such  considerations, 
therefore,  have  led  the  majority  of  psychoclinicists  to  insist 
that  the  essential  quality  to  be  sought  in  a  mental  classifi- 
cation is  not  the  child's  mental  attainments,  nor  his  present 
mental  capacity,  but  his  present  mental  potentialities. 
What  he  is  now  indicates  what  he  will  be  when  his  mental 
powers  reach  their  fullest  development.  And  what  his 
mental  powers  are  when  he  has  reached  his  fullest  develop- 
ment determines  the  class  of  mental  deviates  to  which  he 
is  now  to  be  assigned.  Hence  it  must  be  seen  immediately 
that  the  diagnosis  and  the  prognosis  are  essentially 
blended. 

Usually  Clinic  Children  are  Either  Bad  or  Back- 
ward.— To  take  up  again  the  thread  of  our  diagnosis 
where  we  left  off,  let  us  say  once  more  that  all  clinic  cases 
are  deviates,  either  mental  or  moral.  Usuallj^,  however, 
the  children  brought  to  the  clinic  are  either  bad  or  back- 
ward. The  consideration  of  moral  delinquency  will  be 
reserved  for  a  later  chapter.  At  the  present  time  we  will 
take  up  the  problem  of  backwardness,  and,  first,  let  us  be 
clear  about  the  meaning  of  the  word,  in  order  that  we 
may  escape  the  common  fallacy  of  confusing  the  sj^mp- 
toms  with  the  disease. 

^  Le  Developpement  de  1'  intelligence,  Binet  et  Simon,  L'Annee 
Psychologique,  vol.  14,  p.  91. 


CLASSIFICATION  OF  CLINIC  CASES       101 

What  is  Retardation? — To  say  that  a  child  is  "back- 
ward" or  "retarded"  should  not  allege  or  imply  the 
existence  of  a  physical  or  mental  disease.  It  may,  and 
nearly  always  does,  imply  some  defect  or  some  lack.  But 
that  is  not  always  regrettable.  Is  it  saddening  to  think 
that  "Mary  is  not  forward  in  company,"  or  that  "Johnny 
is  backward  in  swearing"?  Backwardness  in  some  kinds 
of  sophistication  is  by  no  means  an  unmixed  evil.  In 
some  physiological  functions,  too,  like  pubescence,  for 
example,  late  maturity  is,  in  the  minds  of  many,  bene- 
ficial to  the  individual  rather  than  detrimental.  Even  in 
mental  development,  retardation  is  no  more  of  an  evil 
than  precociousness.  The  former  may  lead  to  mere  slow- 
ness of  progress  in  life,  while  the  latter  may  develop  into 
insanity  or  extreme  dulness.  Some  good  traits  may  be 
so  far  advanced  that  they  make  trouble  under  certain 
conditions. 

For  example,  a  boy  six  years  old  was  brought  to  the 
clinic  by  his  mother  and  sister,  aged  about  22.  The  boy 
lived  at  home  with  his  sister,  his  mother  and  his  father, 
the  latter  two  being  in  middle  life.  He  had  been  going  to 
school  for  about  six  months.  During  that  time  he  had 
given  no  trouble  concerning  his  conduct  in  the  school- 
room. His  teacher  reported ,  however,  that  men-  An  Original 
tally   he   had  been  doing  practically  nothing.  ^°^' 

This  was  true  in  spite  of  the  fact  that  his  sister  spent  a 
large  part  of  every  evening  endeavoring  to  teach  him 
his  lessons  for  the  following  day.  To  this  the  boy  did  not 
take  kindly  and  usually  the  sisterly  attempts  to  improve 
his  scholarship  ended  in  a  domestic  storm.  The  sister 
said  he  was  stupid;  the  father  said  he  was  all  right;  the 
mother  simply  folded  her  hands  in  resignation  and  said 
nothing  at  all. 


102     THE  CONSERVATION  OF  THE  CHH.D 

Outside  the  home  some  said  the  boy  was  a  baby,  and 
others  said  he  possessed  a  wisdom  beyond  his  years. 
With  due  gravity  he  would  discuss  topics  ordinarily 
talked  about  only  by  grown  people.  When,  however,  he 
attempted  to  play  with  the  other  boys  and  in  one  of  the 
usual  quarrels  that  arise  in  boyville  one  of  the  other 
youngsters  struck  him,  instead  of  fighting  back  he  would 
immediately  set  up  a  wail  and  run  home  to  his  mother. 
Occasionally  he  attempted  to  play  by  himself  with  his 
automobile,  but  if  he  happened  to  upset  it  and  fall  out 
the  same  lachrymal  result  followed.  This,  according  to 
the  mother's  assurance,  happened  in  spite  of  the  fact  that 
he  was  never  out  of  the  sight  of  his  sister  or  herself! 

In  the  evening  he  spent  part  of  the  time  in  the  cellar 
working  wath  his  father,  who  was  interested  in  mechanical 
contrivances.  The  boy  could  assemble  the  parts  of  elec- 
tric apparatus,  arranging  the  cells,  wire,  and  bells  so  that 
they  would  ring.  He  could  connect  an  incandescent  lamp 
so  that  it  could  be  lighted.  He  could  start  a  gas  engine 
in  the  cellar  and  operate  it.  For  a  six-year-old  boy  of 
rather  light  Vjuild,  he  made  a  good  record  in  this  particular 
line.  In  fact,  it  presaged  what  was  revealed  by  the  Binet 
tests,  namely,  that  the  boy  was  about  one  year  beyond 
the  mental  attainment  of  the  average  child  of  his  age. 
In  school,  however,  he  was  counted  backward ;  at  home, 
by  his  sister,  he  was  declared  stupid. 

The  fact  was  he  was  mentally  advanced,  and  the  diffi- 
culty which  he  encountered  arose  from  the  fact  that  he 
possessed  originality.  It  happened  with  him  that  he  had  a 
father  who  had  accidentally  hit  upon  the  proper  method  of 
education  by  proceeding  from  the  concrete  to  the  abstract. 
The  boy's  perceptions  were  being  trained  as  they  should 
be  for  his  age.     He  was  not  only  allowed,  but  encouraged, 


CLASSIFICATION  OF  CLINIC  CASES       103 

to  vent  all  the  healthy  curiosity  of  a  six-year-old  boy 
in  seeing  things,  handling  things  and  working  with  things. 
During  his  association  with  things,  which  to  him  were 
throbbing  with  living  and  vital  interest,  he  was  storing  up 
visual  memory  images  of  inestimable  value  to  his  future 
intellectual  development.  The  foundations  of  a  true  and 
permanent  education  were  being  laid,  and  laid  so  deeply 
and  solidly  that  they  would  be  able  to  bear  any  further 
intellectual  edifice  reared  upon  them. 

On  the  other  hand,  there  were  great  defects  in  his  all- 
round  development.  His  adult  gravity  was  due  to  his 
association  with  grown  people,  and  his  babyishness  to  the 
lack  of  that  robust  and  vigorous  masculine  development 
which  could  come  to  him  only  by  fighting  his  o^\^l  battles 
in  the  world  of  his  peers.  Both  of  these  faults  would 
dwell  in  any  similar  boy  in  the  same  environment. 

With  these  three  characteristics  of  infantilism,  adultisra 
and  originality,  all  quite  naturally  developing  from  his 
environment  and  from  his  innate  impulses,  the 
ordinary  public  school  had  no  method  of  dealing.  "Gave 

Framed  and  fitted  as  it  is  for  the  average  typical 
child,  it  has  no  room  in  its  system  for  the  one  who  either 
lags  behind  or  pushes  ahead,  and  is  especially  confused 
and  confounded  by  any  pupil  who  is  so  original  and  self- 
expressive  as  to  refuse  to  fit  himself  into  its  traditional 
molds.  Hence  this  boy  gave  trouble  in  school,  but  the 
trouble  that  he  gave  was  due  to  a  very  admirable  trait, 
which  in  later  life  may  make  him  one  of  the  famous  men 
of  his  time.  In  short,  here  was  a  mental  deviate,  but  one 
who  is  distinctly  not  retarded,  at  least  in  anything  except 
in  his  ability  to  play  with  boys  of  his  own  age. 

To  illustrate  again,  a  request  was  made  by  a  school- 
teacher for  advice  concerning  a  ward  of  hers  who  was 


104     THE  CONSERVATION  OF  THE  CHILD 

described  as  a  girl  of  seventeen  with  a  bad  family  history, 
and  who  exhibited  profound  tendencies  toward  petty 
theft,  deceit  and  immoral  conduct.  So  grave  had  these 
tendencies  become  that,  in  the  estimation  of  the  foster- 
An  Ad-  mother,  it  seemed  absolutely  necessary  to  place 
vancedGiri  ^j^^  gjj,j  j^^  somc  institution  where  the  natural 
result  of  her  inclinations  would  be  prevented.  As  she 
lived  in  a  neighboring  town,  it  was  necessary  for  some  one 
to  accompany  her  to  Philadelphia.  This  the  teacher  under- 
took to  do  on  a  day  when  she  had  some  business  in  this 
city.  The  girl  in  question  was  to  be  left  at  a  certain 
place  and  called  for  by  the  social  worker.  Upon  the  morn- 
ing of  her  examination  the  psychologist  in  attendance  was 
informed  by  telephone  that  the  young  lady  who  was  to 
meet  him  on  that  morning  had  arrived  in  the  city,  and  was 
awaiting  the  coming  of  the  social  worker  to  bring  her  for 
examination.  The  sound  of  her  voice,  the  enunciation  and 
manner  of  expressing  herself,  and,  withal,  the  fact  that 
though  she  was  a  country  girl  she  had  enough  initiative  to 
call  by  telephone  in  a  most  busmess-like  way,  and  an- 
nounce the  condition  of  things  in  the  best  form  possible, 
were  enough  to  convince  the  psychologist  that  he  did  not 
have  to  deal  with  a  backward  girl.  The  same  fact  was 
instantly  impressed  upon  the  social  worker  when  she 
arrived  at  the  place  where  the  girl  was  stopping.  She 
found  the  possibly  mentally  deficient  and  morally  imbe- 
cilic  girl  in  the  centre  of  a  group  of  young  ladies  with  whom 
she  had  made  herself  well  acquainted,  and  to  whom  she 
presented  the  social  worker,  after  she  had  introduced 
herself  with  a  display  of  readiness  and  total  lack  of  embar- 
rassment to  be  expected  only  of  one  of  large  experience 
with  the  world.  She  then  informed  the  social  worker  that 
she  was  ready  to  go  to  the  clinic  for  examination,  and 


CLASSIFICATION  OF  CLINIC  CASES       105 

that  one  of  her  new-foimd  friends  had  concluded  to  go 
with  her. 

At  the  clinic  she  exhibited  none  of  the  confusion  or 
shrinking  which  might  have  been  expected,  but  she 
appeared  easy  and  self-confident  in  all  she  said  or  did. 
Because  of  her  home  training  she  observed  the  proper 
decorum  in  everything,  but  underneath  the  proper  exte- 
rior there  appeared  an  obtuseness  or  lack  of  delicacy, 
which  carried  off  things  with  a  saiig  froid  suitable  to  a 
woman  of  twenty-five  over-familiar  with  the  world. 

The  examination  revealed  that  the  girl  had  gone  through 
school  without  any  difficult}-,  in  fact  she  said  that  she  had 
graduated  a  year  before  the  usual  age.  She  was  bright, 
vivacious,  answered  all  the  questions  with  readiness  and 
volunteered  items  of  information  that  showed  her  to  be 
thoughtful  of  things  far  beyond  her  years.  She  had  already 
made  up  her  mind  as  to  her  future  profession  for  life,  and 
had  begun  some  preparation  toward  the  consummation  of 
her  plans.  She  posed  as  a  model  of  decorum.  She  averred 
she  never  went  to  the  theatre,  except  to  see  classic  plays; 
she  did  not  dance;  she  loved  work;  she  never  read  such 
light  literature  as  novels,  nor  indulged  in  any  kinds  of 
ordinarily  frivolous  conversation  or  conduct.  The  associ- 
ation tests,  however,  revealed  that  the  undercurrent  of  her 
mind  seemed  to  run  along  the  ordinary  channels  of  a  girl  of 
her  age.  This  undercurrent  was  somewliat  in  harmony 
with  the  statement  made  about  her  real  conduct,  for,  as  a 
matter  of  fact,  it  indicated  that  she  was  like  the  usual  girl 
of  that  particular  age, — sensitive  to  the  attractions  of  the 
opposite  sex,  and  that  her  protestations  of  whole-souled 
devotion  to  austere  ideals  in  thought  and  conduct  were 
the  result  of  a  sharp  intellect  reacting  to  an  oppressive 
environment.    Due,  in  all  probability,  to  the  fact  that  she 


106     THE  CONSERVATION  OF  THE  CHILD 

was  living  with  an  old  lady  and  under  the  strict  discipline 
of  a  school-teacher,  who  spent  her  evenings  doing  an  excel- 
lent piece  of  religious  service  for  the  community,  her 
sensitivity  on  the  one  point  was  overdeveloped.  At  any 
rate,  it  was  serious  in  the  eyes  of  her  teacher-benefactress, 
who  viewed  such  conduct  of  the  girl,  as  standing  on  the 
street  corner  and  talking  to  several  boy  friends  instead  of 
coming  home  immediately  in  the  evening,  as  shocking 
and  certain  of  leading  her  to  her  early  perdition.  While 
there  was  very  little  in  the  actual  conduct  of  the  girl  to 
forebode  such  a  dreadful  outcome,  much  more  was  to  be 
feared  in  her  general  behavior.     She  was  any- 

Why  She  ,,11  111 

Gave  thmg  but  backward;  her  whole  demeanor  was 

distinctly  forward,  and,  though  not  immodest, 
yet  lacking  in  modesty.  She  was  a  moral  deviate  and, 
judged  by  the  standards  that  rule  the  narrow  feminine 
world  of  her  teacher-friend,  fearfully  and  abnormally  so. 
What  her  future  will  be  is  a  question,  and  a  most  interest- 
ing one,  for  no  doubt  she  possesses  marked  possibilities  for 
good  or  evil.  At  present  the  probability  is  that  she  will 
go  mto  some  good  home  where  there  will  be  given  her  the 
sympathetic  advice  and  direction  she  needs.  The  girl 
does  not  suffer  from  backwardness;  in  fact,  backwardness, 
in  some  respects,  would  be  to  her  a  distinct  advantage 
and  improvement. 

Retardation  is  a  Relation  to  a  Normal. — Retardation, 
then,  let  us  remember,  is  merely  the  name  of  a  relation, 
a  relation,  too,  having  meaning  only  after  some  standard 
of  normal  progress  is  recognized.  It  means  that  the  back- 
ward one  is  behind  someone  else;  he  does  not  go  as  fast  as 
others;  he  does  not  keep  up  with  his  companions.  In 
every  case,  a  standard  or  normal  progress  is  more  or  less 
clearly  implied.    If  the  ordinary  observer  is  asked  to  make 


CLASSIFICATION  OF  CLINIC  CASES       107 

explicit  the  standard  by  which  he  measures  retarded 
children,  he  immediately  replies,  "Why,  the  standard  is 
the  normal  child,"  meaning  by  that  the  usual,  average  or 
typical  child.  In  comparison  with  him  all  others  are 
abnormal,  unusual  or  atypical.  Such  a  proceeding  has 
the  merit  of  simplicitj^  at  least.  The  first  difficult}'  arises 
from  the  fact  that  the  average  normal  or  tj'pical  child 
does  not  exist  in  real  life.  He  cannot  be  sot  up  before 
us  for  examination  and  comparison.  The  precise  mean- 
ing of  the  words  normal,  typical,  and  average  is  hard 
to  give. 

The  Meaning  of  Normal. — However,  they  do  have  a 
meaning,  though  a  somewhat  indefinite  one.  They  refer 
to  an  ideal  in  imagination.  The  ideal  is  a  gro^vth.  Every 
child  seen  makes  an  impression.  From  the  quota  of  these 
impressions  contributed  by  each  child,  gradually  a  com- 
posite mental  picture  grows  up  which  becomes  the  "nor- 
mal" or  "typical"  child.  Those  who  study  the  most 
children  have  the  most  exact  ideal.  Those  children  who 
in  actual  life  diverge  from  this  picture  to  a  more  or  less 
definite  extent,  or  in  certain  characteristics,  are  called 
abnormal  or  atypical.  But,  just  how  to  define  or  accu- 
rately to  describe  in  words  either  the  normal  or  the  ab- 
normal is  difficult  in  the  extreme.  There  are  such  a 
multitude  of  minute  and  individually  insignificant  charac- 
teristics to  be  taken  into  consideration.  In  all  but  extreme 
and  striking  diversions  from  tj'pe,  it  is  the  cumulative 
effect  of  these  many  casually  unnoticed  characteristics 
which  determine  the  experienced  observer  in  his  judg- 
ment, and  gives  that  judgment  more  the  quality  of  an 
intuition  than  of  an  analytic  conclusion.  Because  of 
this  fact,  in  the  examination  of  children,  experience  on 
the  part  of  the  exammer  will  probably  always  count 


108     THE  CONSERVATION  OF  THE  CHILD 

for  more  than  either  methods  of  examination  or  kinds 
of  tests  used. 

To  the  formulation  of  a  standard  of  normality  at  once 
'practicable,  objective  and  precise,  students  have  given  much 
time  and  atteiilion.  Many  have  been  suggested,  and  not  a 
few  systems  of  mental  measurements  based  upon  them 
have  been  developed.  It  would  be  manifestly  impossible 
to  even  notice  all  of  them,  but  three  are  described  here  as 
illustrative  of  the  problems  involved.  For  convenience 
they  may  be  called  the  individual,  the  social,  and  the 
pedagogical  respectively. 

The  first  or  individual  standard  is  an  imaginary  7iorrn. 
It  is  an  attempt  to  measure  the  child  by  himself,  or  by 
what  he  ought  to  be.  That  is,  the  fullest  all-around  devel- 
opment possible  for  each  individual  is  accepted  as  the 
standard  of  each  one's  normal  condition,  and  anything 
short  of  that  is  called  retardation.  Prima  facie,  the  meas- 
ure has  claims  to  consideration.  But  what  one  ought  to 
be  or  would  be  under  right  conditions,  mentally,  physically 
or  morally,  is  purely  imaginary  or  problematical.  Prob- 
ably no  one  feels  that  he  has  had  the  fullest  and  fairest 
chance,  and  that  with  some  other  possible  environment 
and  training  he  would  have  been  far  more  advanced  intel- 
lectually, and  possibly  his  acquaintances  concur  in  the 
opinion.  The  acceptance  of  such  a  judgment,  therefore, 
would  make  us  all  "backward  "or  "retarded,"  and,  worse 
still,  it  would  make  a  fully  educated  idiot  normal!  Even 
if  the  standard  of  fullest  development  is  rendered  more 
precise,  and  to  some  extent  objective,  by  saying  it  consists 
in  the  most  perfect  possible  development  of  each  individ- 
ual cortical  cell  and  cerebral  tract,  it  comes  no  nearer  to  a 
feasible  application.  The  perfection  of  cerebral  systems— 
to  say  nothing  of  reflex  centres  and  peripheral  organs — is 


CLASSIFICATION  OF  CLINIC  CASES       109 

as   remotely   imaginable   as    the    possible    perfection    of 
psychic  powers. 

Quite  naturally,  the  second  or  social  sfnmlard  has  come 
into  existence.  It  represents  the  judgment  of  the  commun- 
ity upon  any  one's  mental  ability  made  by  comparing 
him  with  others  in  their  daily  lives  of  work  and  play. 
The  e very-day  observation  that  a  certain  child  does  not 
learn  common  things  like  dressing,  washing,  eating  and 
playing  games  as  rapidly  as  his  brothers  and  sisters  did 
at  his  age,  or  as  readily  as  his  companions  do,  may  be  of 
value  and  significance  in  so  far  as  it  calls  attention  to  the 
need  of  fuller  investigation.  But  the  social  standard 
expressed  in  the  opinions  of  parents,  friends  or  teachers 
is  altogether  too  biased  and  too  crude  to  act  as  a  scientific 
measurement.  Though  it  may  go  so  far  as  to  establish 
the  presumption  that  the  child  is  backward  and  thus  lead 
to  further  examination,  it  does  not  begin  to  be  precise 
enough  for  determining  the  exact  degree  of  the  back- 
wardness. Dr.  Tredgold  attempts  to  make  this  judgment 
somewhat  more  definite  by  indicating  what  degree  of 
mentality  a  normal  person  must  have.  "Our  best  defi- 
nition of  the  'normal'  mind,"  he  says,  "must  be     ^  ,  . . 

'  .  Definition 

a  degree  of  intellectual   capacity  sufficient  to        ,,      of 

*^  .  .  Normal 

enable  its  possessor  to  perform  his  duties  as  a 
member  of  society  in  that  position  to  which  he  was  born." 
This  definition,  of  course,  as  Dr.  Tredgold  himself  points 
out,  will  make  normality,  and  consequently  mental  defi- 
ciency, depend  to  a  great  degree  upon  social  circumstances. 
If,  in  any  social  stratum,  the  struggle  for  existence  can  be 
made  easy  b}""  artificial  conditions  like  the  possession  of 
wealth  and  the  ability  to  command  abundance  of  aid,  the 

"Mental  Deficiency,  A.  F.  Tredgold,  1908,  p.  2. 


110     THE  CONSERVATION  OF  THE  CHILD 

mentality  of  the  person  so  situated  can  by  no  means  be 
determined  in  comparison  with  that  of  other  people  in 
harder  circumstances.  A  society  woman  may  maintain 
her  prestige,  a  king,  aided  by  a  wise  counsellor,  may 
retain  his  throne,  and  a  rich  idler  may  pass  muster  as  a 
"good  fellow"  all  his  life,  and  yet  all  of  them  be  feeble- 
minded in  the  technical  sense  of  that  word.  Yet  this 
definition,  from  many  points  of  view,  is  one  of  the  best  we 
have  at  the  present  time. 

To  invest  this  indeterminate  standard  with  more  pre- 
cision, Binet  made  tests  upon  several  hundred  normal 
children,  and  from  his  experiment  developed  a  set  of 
questions  and  tasks  which  he  believes  have  the  desired 
qualifications  for  accurately  and  absolutely  determining 
the  degree  of  backwardness  of  any  child  independent  of 
his  social  position  or  of  any  pedagogical  training  which 
it  may  have  had.  The  essentials  of  his  standard  are  con- 
tained in  the  following  quotation : 

"The  intellectual  faculty  appears  to  us  to  be  independent  not 
only  of  instruction,  but  of  that  which  we  might  call  the  academic 
faculty;  that  is  to  say,  the  faculty  to  learn  at  school,  the  faculty  of 
assimilating  the  instructions  given  at  school  with  the  method  used 
at  school. 

"  In  our  former  researches  concerning  the  recruiting  of  the  abnor- 
mal, feebleness  of  the  academic  faculty  was  the  sole  criterion  of 
normality  employed.  We  said: — Every  scholar  is  abnormal  who  is 
retarded  three  years  in  his  studies  if  that  retardation  is  not  excusable 
on  account  of  insufficient  time  spent  at  school.  It  seems  to  us  wise 
and  prudent  to  admit  that  this  academic  aptitude  does  not  in  all 
cases  necessarily  accompany  the  intellectual  faculty  which  we  meas- 
ure by  our  method.  From  the  first,  theoretical  reasons  have  induced 
us  to  avoid  this  confusion.  It  seems  to  us  that  the  academic  apti- 
tude depends  upon  something  else  than  intelligence.  For  success  in 
study  certain  qualities  are  necessary  which  depend  above  all  upon 
attention,  upon  will,  upon  the  character,  for  example:  a  certain 
docility,  a  regularity  of  habits,  and  above  all  a  continuity  of  effort. 
Even  an  intelligent  child  would  learn  little  in  class  if  he  never  list- 


CLASSIFICATION  OF  CLINIC  CASES       111 

ened,  if  he  passed  his  time  in  inakins  notches  in  his  desk,  chuckling, 
and  in  'cutting'  as  a  bad  soldier.  The  insufficiency  of  attention,  of 
character,  and  of  will,  show  themselves  not  at  all,  or  very  slightly, 
in  our  examination  of  intelligence;  the  test  is  too  short  and  the  child 
is  not  left  enough  to  himself.  In  fact,  we  have  never  encountered  in 
our  examinations  any  inattentive  children  except  among  those  be- 
tween three  and  four  years  of  age.  All  of  them  made  great  effort; 
they  were  with  us  and  our  presence  alone  would  have  sufficed  to 
prevent  inattention.  There  is  nothing  in  the  conditions  of  this 
test  by  which  one  is  able  to  measure  the  ordinary  distractions  of 
attention  of  the  child  such  as  occur  when  he  is  left  to  himself."  '* 

The  third  measure  of  retardation  is  the  pedagogical. 
It  is  limited  to  a  rather  narrow  field,  but  within  that  field 
is  perfectly  defined  and  objective.  Since,  also,  a  large 
number  of  the  cases  coming  to  the  psychological  clinic 
are  children  whose  difficulty  is  backwardness  in  their 
school  work,  it  would  seem  justifiable  to  give  a  somewhat 
large  consideration  to  this  method  of  measurement  in 
this  connection. 

The  Pedagogical  Standard. — Since  retardation  is  a 
school  phenomenon  and  since  the  first  attempts  to  give 
it  anything  like  scientific  attention  were  made  in  public 
schools,  class-grades  were  turned  to  for  aid.  Assuming 
that  a  normal  pupil  was  promoted  from  one  grade  to  an- 
other each  year,  early  investigators  adopted  for  their  first 
standard  the  correspondence  between  grade  standing  and 
age.  Thus,  the  children  who  began  school  at  the  legal 
age  and  were  promoted  every  year  were  counted  normal; 
those  in  the  same  grade  who  were  older  by  at  least  one 
year  than  the  normal  pupil  were  considered  backward  or 
retarded.  However,  it  was  soon  discovered  that  in  the 
school  under  investigation  such  a  standard  would  throw 
nearly  three-quarters  of  the  pupils  into  the  backward 

*  L'Annee  Psychologique,  Tome  xiv,  1908,  p.  75. 


4 


112     THE  CONSERVATION  OF  THE  CHILD 

class.  Therefore,  the  norm  was  changed  and  only  those 
who  were  two  years  or  more  behind  the  grade  correspond- 
ing to  their  age  were  retarded.  A  concrete  illustration 
will  make  the  modus  operandi  clearer. 

Dr.  Witmer  writes  of  his  first  attempts  to  define  retar- 
dation. "I  undertook,"  he  says,  "to  define  as  pedagog- 
ical retardation  the  number  of  years  that  a  child  was 
behind  the  grade  for  his  age.  If  we  wish  to  ascertain  the 
causes  of  retardation  in  school  children  we  must  first 
obtain  the  whole  number  of  retarded  children  irrespective 
of  any  preconceptions  we  may  have  as  to  the  causes. 
Pedagogical  retardation  follows  from  the  supposition  that 
a  child  enters  upon  the  first  years  of  school  work  before  he 
has  passed  his  seventh  birthday.  If  he  advances  one 
grade  each  year,  he  will  complete  the  eight  years  of  the 
elementary  course  before  he  has  passed  his  fifteenth  birth- 
day. This  establishes  a  theoretical  age  limit  for  each 
grade,  apparently  not  excessive  in  its  educational  require- 
ments, for  the  child  that  leaves  the  elementary  schools 
in  his  fifteenth  year  cannot  complete  the  high  school  before 
his  nineteenth  year,  nor  graduate  from  college  before  his 
twenty-third  year,  and  yet  in  the  elementary  schools  in 
Camden  72  per  cent,  of  the  children  exceed  this  theoret- 
ical age  limit.  It  seemed  absurd  to  assert  that  72  per 
_,    _  cent,  of  a  city  school  system  were  retarded,  and, 

tionai  moreover,  the  group   of    children    obtamed    m 

Standard  '  ,  tiki 

this  way  was  too  large  to  be  studied  for  the  pur- 
pose of  discovering  the  causes  of  their  retardation.  It  was 
therefore  determined  to  allow  one  or  more  years  in  excess 
of  this  theoretic  age  limit.  In  the  city  of  Camden  47  per 
cent,  were  found  to  exceed  the  age  limit  by  one  year  or 
more,  26  per  cent,  by  two  years  or  more,  13  per  cent,  by 
three  years  or  more,  and  5  per  cent,  by  four  years  or  more. 


CLASSIFICATION  OF  CLINIC  CASES       113 

It  was  determined  to  call  all  those  children  pedagogically 
retarded  who  exceeded  the  age  limit  by  two  years  or  more. 
This  definition  of  retardation  has  been  generally  accepted 
in  subsequent  investigations  of  retardation  statistics  in 
other  cities."" 

The  latest  considerations  have  not  materially  altered 
the  standard  first  suggested,  as  is  shown  in  Mr.  Ayres' 
statement: 

"The  method  of  determining  the  number  of  retarded 
children  in  a  given  school  system  which  has  received  most 
general  acceptance  on  the  part  of  school  men  is  Ayrea* 
the  method  which  enumerates  the  children  by  standard 
ages  and  grades  and  puts  all  of  the  children  who  are  older 
than  a  determined  age  in  each  grade  into  a  group  desig- 
nated 'Above  Normal  Age.'  These  children  who  are  older 
than  they  should  be  for  the  grade  they  are  in  are  consid- 
ered '  retarded.'  Thus  used  the  term  designates  a  condition 
and  it  is  applied  with  equal  propriety  to  those  children 
who  are  over  age  on  account  of  slow  progress,  and  those 
who  have  progressed  normally  but  entered  school  late. 

"The  method  has  come  into  general  acceptance  because, 
all  things  considered,  it  is  the  most  satisfactory  standard 
by  which  to  measure  retardation. 

"Statistics  based  on  the  time  pupils  have  spent  in  each 
grade  are  exceedingly  rare,  often  unreliable,  and  usually 
are  noncumulative.  That  is,  they  deal  with  each  grade 
as  a  separate  unit  and  fail  to  tell  us  how  much  time  the 
pupil  has  gained  or  lost  in  the  entire  course. 

"Statistics  giving  us  the  figures  as  to  grade  and  age 
distribution,  on  the  other  hand,  are  simple,  certain,  easy 
to  gather,  and  embody  valuable  information  as  to  many 

*\\Tiat  is  Meant  by  Retardation?  Lightner  Witmer,  Psycho- 
logical Clinic,  vol.  iv,  No.  5,  Oct.  15,  1910,  pp.  128,  129. 


114     THE  CONSERVATION  OF  THE  CHILD 

conditions  and  results  of  school  work.  Their  application 
to  the  problem  of  retardation  is  so  easy  that  the  process 
may  be  developed  by  any  one,  however  unversed  in  statis- 
tical procedure."^" 

Backwardness  Alone  does  not  Classify  a  Child. — 
From  our  study  of  backwardness  we  are  now  able  to  see 
that  "backwardness"  is  not  a  disease,  nor  a  fixed  condi- 
tion, nor  even  a  fault.  It  has  many  meanings  or,  until  a 
standard  is  explicitly  stated,  it  has  no  meaning.  It  can- 
not be  accepted  as  a  "diagnostic  symptom"  in  any  case. 
All  slow,  dull,  stupid,  borderland,  feeble-minded,  imbe- 
cilic,  and  idiotic  children  may  be  backward.  Some  bright, 
quick,  witty,  brilliant,  talented,  children,  who  may  later 
in  life  become  famous  men  and  women,  may  be  backward. 
Writers  on  child-psychologj^  like  Hall  and  Swift  have 
shown  the  entire  possibility  of  such  cases.  School  children, 
without  brain  lesions  and  without  physical  defects  of  any 
kind,  may  be  backward.  Children  may  be  retarded  ped- 
agogically  and  advanced  socially,  or  vice  versa.  Back- 
wardness, or  retardation,  in  itself  and  by  itself,  is  not  a 
mark  by  which  any  large  or  fruitful  classification  of 
children  can  be  made,  and,  we  repeat,  is  absolutely  useless 
and  even  harmful  as  a  designation,  unless  the  standard  by 
which  the  backwardness  is  measured  is  made  clear  and 
explicit. 

Curable  and  Incurable  Backwardness. — In  relation 
to  some  chosen  standard  backwardness  is  a  fact  of  obser- 
vation. To  make  it  significant  for  the  clinicist  it  must 
have  some  further  attributes.  Upon  the  principle  of 
classification  we  have  already  laid  down  that  additional 
attribute  is  "curable  "  or  "incurable."    If  a  child  is  curably 

1°  Laggards  in  Our  Schools,  Leonard  P.  Ayres,  pp.  36,  37. 


CLASSIFICATION  OF  CLINIC  CASES       115 

backward,  he,  by  that  fact  alone,  enters  into  one  great 
class  of  children  retarded  from  any  cause  whatsoever;  if 
he  is  incurably  backward,  he  enters  at  once  into  another 
great  class  commonly  called  feeble-minded  or  mentally 
defective.  Such  a  distinction  is  fraught  with  the  gravest 
practical  importance  for  the  child  and  all  concerned  with 
him.  The  determination  of  this  vital  step  is  one  of  the 
most  important  in  making  a  diagnosis.  How  it  is  to  be 
done,  by  what  examinations  and  tests,  is  reserved  for  the 
next  chapter.  Sufficient  is  it  now  to  say  that  the  dis- 
tinction does  not  rest  upon  any  symptom-complex  or 
appearance  of  the  child  alone.  Curably  backward  and 
incurably  backward  children  often  look  exactly  alike, 
know  about  the  same  amount  of  school  lore,  act  about 
alike  in  society  and,  sometimes  even, — if  there  is  any 
advantage  either  way, — the  incurably  backward  or  feeble- 
minded child  has  it.  A  kno^^^l  feeble-minded  boy  came 
from  an  institution  and  was  able  to  graduate  from  a 
manual  training  high-school  in  one  of  our  eastern  cities. 
Others  have  entered  college  and  some  of  them  have  been 
graduated,  and  a  few  of  such  have  given  a  fairly  good 
account  of  themselves  in  the  world.  One  of  the  commonest 
tragedies  of  our  social  life  is  to  discover  that  a  father  or 
mother  is  feeble-minded  only  after  the  birth  of  an  imbe- 
cilic  child. 

Sub-classifications  of  the  Curably  Retarded. — So  far 
we  have  ditTcrcntiatcd  between  two  groat  classes  of 
mentally  retarded  children.  Before  us  lies  the  immediate 
task  of  further  sub-classifying  the  two  classes.  For  the 
incurably  retarded  this  is  not  difficult.  Much  has  been 
done  already  and  the  schemes  are  fairly  simplified.  Not 
so  for  the  curably  backward.  They  furnish  chiefly  a 
pedagogical  problem  and  as  yet  not  enough  has  been 


116     THE  CONSERVATION  OF  THE  CHILD 

done  to  bring  out  clear  and  well-accepted  separations  of 
the  varieties  into  groups.  Dr.  Groszmann  offers  a  social 
classification  as  follows: 

Subnormal  Children 
(Those  whose  potentials  are  incomplete  or  undeveloped) 

1.  Defective  Children.  Hereditary  and  congenital 
causes. 

Epileptics,  blind,  deaf-and-dumb,  deformed,  paralytics, 
crippled,  etc.  These  children  can  never  attain  the  perfect 
norm  of  human  nature,  as  their  -potentials  are  incomplete. 

2.  Children  of  Arrested  Development.  (Acquired  ab- 
normality or  defectiveness.) 

a.  Pathological  Classes.  Children  born  apparently 
normal  but  having  their  development  checked  by: 

1.  Hereditary  causes,  manifesting  themselves  at  cer- 
tain development  periods. 

2.  Special  causes,  as  diseases,  fright,  accidents,  etc. 
The  arrest  of  development  may  be  only  partial,  as  in  the 
case  of  children  deformed  by  accident;  then  there  will  be 
mainly  a  condition  of  incompleteness,  as  in  Group  1, 
Defective  Children. 

6.  Submerged  Classes. 

Environmental  influences  have  prevented  them  from 
attaining  full  maturity. 

Children  of  arrested  development  will  remain  essentially 
subnormal,  no  matter  how  well  they  may  he  educated  within 
their  limits. 

3.  Children  of  Rudimentary  or  Atavistic  Development. 
The  primitive  type,  representing  mental,  moral,  and 
social  instincts  and  activities  on  the  savage,  barbarian,  or 
generally  uncivilized  level. 

Primitive  races. 


^^^^^^^^F^^ 

■ 

1 

^    1  ^^     1  ^' 

^ 

Menially  I'lManlcd  nii  acctjunt 
of  tubcrcuhir  iiila'rilance,  mal- 
nutrition, and  utiC'lesa  teeth. 


jNIentally  retarded  un  account 
of  malnutrition  and  other  phy- 
sical defects. 


Menially  rclardcd  uu  account 
of  ncjilect,  nuilnutrilion,  defec- 
tive eyes,  and  speech  defecl. 


On  the  borderland.  Mighi  be 
saveil  by  medical  treatment  and 
a  chansie  of  environment. 


CLASSIFICATION  OF  CLINIC  CASES       117 

Atavistic  individuals.  These  approach  the  abnormal 
level.  They  represent  a  revision  of  instincts  and  capaci- 
ties in  spite  of  being  born  from  apparently  normal  parents. 

Dr.  Bruner  divides  school  children  into  five  grades,  two 
of  which  are  the  "typically  retarded"  and  the  "back- 
ward children."" 

For  the  purpose  we  have  in  view,  probably  the  best 
principle  of  sub-classification  for  curably  backward  chil- 
dren is  that  suggested  by  Dr.  Witmer  and  rests  upon  the 
speed  with  which  they  recover  their  normal  position  in 
society  or  in  school.  According  to  this  method  we  will 
place  in  the  first  class  those  who  are  immediately  curable, 
meaning  by  this  that  as  soon  as  the  physical  defects 
within  the  child  himself,  or  in  his  surroundings,  are  cor- 
rected or  removed,  he  immediately  takes  his  proper  place 
in  school  or  in  society. 

A,  L.,  Case  428,  is  a  girl  eight  years  old,  who  was 
brought  to  the  clinic  for  retardation  work.  There  was 
nothing  in  her  personal  history  nor  in  the  family  history 
to  lead  to  the  belief  that  she  might  be  permanently  men- 
tally defective,  and  her  home  environment,  while  poor, 
was  pleasant  and  neat. 

However,  the  physical  examination  brought  out  the 
facts  that  her  eyes  were  irritated,  her  teeth  crooked,  and 
her  tonsils  enlarged.  She  was  taken  to  the  ej^e  clinic, 
where  it  was  found  that  she  did  not  need  glasses  at  pres- 
ent, but  the  advice  was  given  that  a  lookout  be  kept  for 
headaches  and  eye-strain  as  she  grew  older.  At  the  nose 
and  throat  clinic,  adenoids  and  enlarged  tonsils  were  diag- 
nosed. She  was  taken  to  the  University  of  Pennsylvania 
Hospital,  and  operated  upon  for  both  of  these  defects. 

"  Proceedings  of  the  National  Educational  Association,  1909, 
Abnormal  Children,  Frank  G.  Bruner. 


118     THE  CONSERVATION  OF  THE  CHILD 

She  was  again  returned  to  her  home,  and  again  attended 
the  pubhc  school  as  usual.  Her  mother  noticed  an  imme- 
diate improvement  in  her  appetite,  and  was  ])leased  to 
find  that  the  child  was  not  perpetually  taking  cold  in  her 
head  as  she  had  done  before.  Later  on  the  mother  also 
reported  that  A.  L.'s  teeth  were  straightening  somewhat 
and  that  altogether  she  was  in  better  health. 

At  school  the  teacher  promoted  her  on  age,  and  found 
her  quite  able  to  keep  up  with  the  work  of  the  higher 
grade,  proving  that  she  had  immediately  recovered  from 
her  backwardness  after  the  necessary  surgical  treatment 
brought  about  by  her  visit  to  the  clinic. 

A  second  class  is  composed  of  those  who  are  rapidly 
recoverable.  This  includes  all  who  require  a  period  of 
pedagogical  training  after  the  removal  of  their  physical 
defects.  During  that  time  they  make  rapid  progress,  and 
in  a  comparatively  short  time  regain  lost  ground. 

A  third  class  may  be  called  the  slowly  recoverable, 
including  all  those  children  who  require  a  long,  careful 
and  persistent  course  of  education  after  the  removal  of 
the  physical  defects,  before  they  are  again  able  to  take 
their  places  with  normal  children.  It  can  be  immediately 
seen  that  this  last  class  forms  a  difficult  group  to  classify 
because  the  clinical  picture  they  present  and  the  time 
they  require  to  show  improvement  seem  to  ally  them 
with  the  class  of  permanent  mental  defectives.  Their 
recovery  is  so  very  slow  and  tedious,  and  oftentimes  pos- 
sible only  under  the  best  environment  and  training,  that 
judgment  as  to  the  final  classification  must  frequently  be 
held  in  al)eyance  for  a  long  time. 

Summary. — We  have  now  made  this  much  progress 
toward  determining  the  classes  to  which  clinic  cases  must 
be  assigned:  all  of  them  are  mental  or  moral  deviates;  all 


CLASSIFICATION  OF  CLINIC  CASES       119 

arc  curable  or  incurable  deviates;  this  fact  has  peculiar 
significance  to  the  mentally  retarded  cases ;  of  the  cural)ly 
backward  there  are  several  sub-classifications:  the  imme- 
diately recoverable,  the  rapidly  recoverable,  the  slowly 
recoverable.  We  will  now  turn  to  the  second  great  divi- 
sion of  incurably  backward  children  and  learn  what  we 
can  of  the  classification  and  sub-classification  in  common 
\  use  for  their  assignment. 
>^  Definitions  of  the  Incurably  Retarded. — That  great 
class  of  children  who  must  be  classified  as  incurably  back- 
ward belong  to  the  group  technically  known  as  mental 
defectives,  dements  or  aments.  To  define  exactly  what 
dementia  or  amentia  is,  is  one  of  the  difficult  problems  of 
the  study.  The  difficulties  encountered  by  Seguin  in  1866 
are  still  present.  He  undertook  to  define  idiocy  and  to 
give  the  synonyms  "named  by  Savage,  Amentia;  by 
Segar,  Imhecililes  ingenii;  by  Vogel,  Fatuitas  ingenii;  by 
Linnaeus,  Morosis;  by  Cullen  and  Fodere,  Demence  innee; 
by  Willis,  Stupidiias;  by  Pinel,  Idiotism;  by  some  English 
^vriters,  Idiotcy;  by  Esquirel  and  the  majority  of  encyclo- 
paedias and  dictionaries,  Idiocy. 

"We  shall  use  this  latter  term,"  he  continues,  "to 
express  the  physiological  infirmity,  and  would  like  to  see 
the  name  given  to  it  by  Pinel, — Idiotism, — preserved  to 
express  the  specific  condition  of  mind  pertaining  to  idiocy. 
"Its  definitions  have  been  so  numerous,  they  are  so 
different  one  from  the  other,  and  they  have  so  little  bear- 
ing on  the  treatment,  that  their  omission  cannot  be  much 
felt  in  a  practical  treatise.  Our  own,  if  objectionable,  will 
be  fomid  at  least  to  correspond  to  a  plan  of  treatment, 
both  supporting  each  other;  and  may  suffice  until  a  better 
definition  and  a  better  treatment  can  be  devised."  He 
then  olTcrs  his  definition  in  the  following  terms: 


120     THE  CONSERVATION  OF  THE  CHILD 

"Idiocy  is  a  specific  infirmity  of  the  cranio-spinal  axis, 
produced  by  deficiency  of  nutrition  in  utero  and  in  neo- 
seguin's  nati.  It  incapacitates  mostly  the  functions 
Definition  ^jjjgjj  gjyg  j.\qq  ^q  the  reflcx,  instinctive,  and 
conscious  phenomena  of  life;  consequently,  the  idiot 
moves,  feels,  understands,  wills,  but  imperfectly;  does 
nothing,  thinks  of  nothing,  cares  for  nothing  (extreme 
cases),  he  is  a  minor  legally  irresponsible;  isolated,  without 
associations;  a  soul  shut  up  in  imperfect  organs,  and 
innocent."^^ 

However,  what  is  generally  meant  by  the  word  is  clear 
enough.  As  Dr.  Tredgold  says,  "The  essence  of  mental 
defect  is  that  it  is  incurable,  and  by  no  'special'  educa- 
tion, however  elaborate,  can  a  case  of  amentia  be  raised 
to  the  normal  standard.  Some  defect  must  always  remain, 
and  upon  this  fact  all  authorities  agree."  ^' 

In  a  previous  portion  of  the  same  work,  between  "de- 
mentia" and  "amentia"  he  has  made  a  distmction, 
Tredgoid's  dependent  upon  the  previous  mental  develop- 
Definition  ^^^^  ^f  ^^xe  suffcrcr.  In  that  place  he  says, 
"Mental  defect  occurring  subsequently  to  mental  devel- 
opment may  be  compared  to  a  state  of  bankruptcy,  and 
is  more  fittingly  described  as  dementia  (de,  down,  from; 
mens,  mind);  whilst  the  person  whose  mind  has  never 
attained  normal  development  may  be  looked  upon  as 
never  having  had  a  bank  account,  and  this  state  is  desig- 
nated amentia  (a,  without;  mens,  mind).  In  both  of  these, 
of  course,  there  is  literally  mental  deficiency;  but  in  view 
of  the  convenient  and  growing  tendency  to  restrict  this 
term  to  the  latter  class,  I  shall  in  this  book  use  it  in  a 
specific  sense  as  synonymous  with  'amentia.'  "^* 

"  Idiocy  and  its  Treatment,  P^dward  Seguin,  1866. 
i»  Mental  Deficiency,  A.  F.  Tredgold,  p.  127. 
"  Ibid.,  p.  1. 


CLASSIFICATION  OF  CLINIC  CASES       121 

He  then  proceeds  to  define  amentia  as  "a  state  of 
mental  defect  from  birth,  or  from  an  early  age,  due  to 
incomplete  cerebral  development,  in  consequence  of  which 
the  person  affected  is  unable  to  perform  his  duties  as 
a  member  of  society  in  the  position  of  life  to  which  he 
is  born."  *^ 

It  mil  be  noted  that  this  definition  is  partially  causal. 
It  vests  the  reason  for  the  mental  defect  in  an  incomplete 
cerebral  development,  but,  on  the  other  hand,  it  is  also 
prognostic  in  the  sense  that  it  asserts  the  permanent  ina- 
bility of  the  affected  person  to  perform  his  duties  as  a 
member  of  society.  This  is  in  agreement  with  his  state- 
ment that  the  essential  characteristic  of  amentia  is  its 
incurableness. 

It  is  to  be  noted,  also,  that  this  definition  places  the  essence 
of  amerUia  in  its  incurability.  It  is  in  thorough  accord 
with  the  problem  of  classification  presented  in  this  chap- 
ter as  the  particular  one  to  be  solved  by  clinical  classifica- 
tion. We  have  said  that  the  cases  that  come  to  the  clinic 
are  already  part  classified  to  the  extent  of  declaring  that 
they  are  mental  or  moral  deviates.  Of  the  mental  devi- 
ates, by  far  the  largest  number  manifest  their  deviation 
from  the  normal  by  their  mental  retardation.  Concern- 
ing this,  the  immediate  question  is  whether  retardation  is 
permanent  or  temporary.  If  it  is  permanent,  by  the 
definition  given  above,  the  retarded  mental  deviate  must 
be  classed  as  an  ament.  This  step  in  the  classification, 
though,  in  a  sense  rough,  imperfect,  and  incomplete,  from 
the  point  of  view  of  a  thoroughgoing  classification  is 
still  vital  and  final.  That  is  to  say,  once  that  a  child  is 
classified  as  an  ament,  he  is  shut  off  from  the  possibility 

1'  Mental  Deficiency,  A.  F.  Tredgold,  p.  2. 


122     THE  CONSERVATION  OF  THE  CHILD 

of  being  classified  as  a  normal  person.  As  to  his  future 
career,  as  has  been  said  more  than  once  before,  this  step 
is  of  the  most  vital  significance,  as  upon  it  hinge  his 
training,  treatment  and  final  disposal. 

To  again  quote  our  authority,  "It  is  not,  however,  to 
be  assumed  that  amentia  is  merely  a  subtraction  in  vary- 
Amentia  ia  i^ig  degree  from  the  normal.  Although  the 
MettaT'"**'  contrary  might  be  thought,  nevertheless  the 
status  ^^yQ  conditions  do  not  merge  into  one  another, 
and  between  the  lowest  normal  and  the  highest  ament  a 
great  and  impassable  gulf  is  fixed.  Whilst  the  former  is 
heavy,  stolid,  and  uniformly  dull-witted,  he  has  yet  suf- 
ficient common  sense  to  look  after  his  interests  and  hold 
his  own  in  that  environment  in  which  Nature  has  placed 
him.  The  mildest  ament,  on  the  other  hand,  may  show 
no  apparent  dulness;  he  may  even  be  bright  and  vivacious; 
and  in  some  of  his  abilities  immeasurably  superior  to  the 
clodhopper.  But  the  other  faculties  of  his  mind  are  not 
present  in  like  proportion.  Instead  of  harmonious  work- 
ing, there  is  discord,  and  in  possession  of  that  essential  to 
independent  existence — common  sense — he  is  lacking, 
and  the  want  can  never  be  supplied. 

"The  difference  has  been  well  described  by  Sir  J.  Batty 
Tuke,  who  says:  'Where  in  theory  the  morbid  and  the 
healthy  types  might  be  supposed  to  approach  each  other, 
we  find  in  practice  that  no  such  debatable  ground  exists. 
The  uniformity  of  dulness  in  the  former  stands  in  marked 
opposition  to  the  irregularity  of  mental  conformation  in 
the  latter.' "i« 

Sub-classification  of  the  Incurably  Retarded. — The 
next  step  in  the  classification  is  the  assignment  of  the 

'8  Mental  Deficiency  A.  F.  Tredgold,  pp.  2,  3. 


CLASSIFICATION  OF  CLINIC  CASES       123 

ament  to  that  particular  sub-class  of  imbeciles  or  idiots 
to  which  he  belongs  by  reason  of  his  degree  of  mentality. 
For  it  must  be  remembered  that  up  to  a  certain  limit  all 
degrees  of  mentality  are  represented  amongst  the  mental 
defectives. 

The  most  usual  sub-classification  divides  amentia  into 
three  divisions  or  degrees.  Beginning  with  the  nearest 
to  normal,  Dr.  Tredgold  has  assigned  to  this  Feeble- 
class  the  name  feeble-minded,  or  higli-grade  '"'"'''^'^'^^^ 
amentia.  This,  he  says,  "Is  the  mildest  degree  of  mental 
defect,  and  the  feeble-minded  person  is  'one  who  is  capable 
of  earning  a  living  under  favorable  circumstances,  but  is 
incapable  from  mental  defect  existing  from  birth,  or  from  an 
early  age,  (a)  of  competing  on  equal  terms  with  his  normal 
fellows;  or  (b)  of  managing  himself  and  his  affairs  with  ' 
ordinary  prudence.'  "" 

"Imbecility  (Medium-Grade  Amentia). — The  imbe-  1 
cile  is  defined  as  'one  who,  by  reason  of  mental 

7  J.  .     ,         .  7  •     I  ,.  7  Imbecility 

defect  existing  from  birth,  or  from  an  early  age,  is 
incapable  of  earning  his  own  living,  but  is  capable  of  guard- 
ing himself  against  common  physical  dangers.' 

"Idiocy  (Low-Grade  Amentia). — The   idiot    is    de- 
fined as  'a  person  so  deeply  defective  in  mind 
from  birth,  or  from  an  early  age,   that  he  is 
unable  to  guard  himself  against  common  physical  dan- 
gers.' "  18 

Dr.  Tredgold's  classification  is,  to  a  large  extent,  social, 
in  that  it  rests  upon  the  ability  or  inability  of  the  affected 
person  to  take  his  place  in  society. 

"A.  F.  Tredgold,  Mental  Deficiency,  1908,  p.  7.5.  This  and  the 
following  definitions  from  Tredgold  were  suggested  by  the  Royal 
College  of  Physicians  of  London. 

'*  Ibid.,  pp.  75  and  76. 


124     THE  CONSERVATION  OF  THE  CHH.D 

Qoddard's  Classification. — Still  another  classifica- 
tion is  that  used  by  the  Vineland  Training  School,  of 
Vineland,  N.  J.,  which  is  similar  to  the  one  of  Dr.  Tred- 
gold,  with  the  exception  that  in  the  place  of  "feeble- 
minded" the  word  "moron"  (from  the  Greek  word  mean- 
ing fool)  is  substituted. 

"We  presented  to  the  American  Association  for  the 
Study  of  the  Feeble-minded,  at  its  meeting  this  year,  an 
industrial  classification,  which  it  has  tentatively  adopted. 
The  feeble-minded  are  divided  into  three  large  groups, 
very  much  as  has  been  done  in  the  past, — the  lowest  grade 
is  called  'idiots/  the  middle  grade  'imbeciles,*  and  the 
highest  grade,  who  were  formerly  called  'feeble-minded,' 
we  now  propose  to  call  by  an  entirely  new  term,  'moron.' 
This  is  a  Greek  word,  and  means  those  who  are  mainly 
lacking  in  judgment  and  good  sense.  Each  of  these  groups 
may  again  be  divided  into  three, — the  high,  middle  and 
the  low,  thus  making  nine  degrees  of  defectiveness,  all 
told,  wuth  ten  in  the  scale  standing  for  the  normal  child, 
including  those  who  are  simply  backward.  The  low- 
grade  idiot  is  the  perfectly  helpless  child,  the  middle-grade 
idiot  the  one  who  is  able  to  feed  himself,  but  who  eats 
almost  anything;  the  high-grade  idiot  the  child  who  eats 
with  some  discrimination,  discarding  that  which  is  not 
food.  The  low-grade  imbecile,  he  who  can  do  simple 
tasks,  very  simple  indeed;  the  high-grade  imbecile,  the 
one  who  can  do  tasks  of  short  duration  and  little  errands 
in  the  house, — washing  dishes,  scrubbing  floors,  washing 
and  sweeping,  perhaps.  The  low-grade  moron,  the  boys 
and  girls  who  can  run  errands,  do  light  work,  make  beds, 
etc.,  scrub,  mend,  care  for  a  room,  if  there  is  no  great 
complexity  of  furniture;  the  middle-grade  morons,  those 
who  can  do  institution  routine  work;  and  the  high-grade 


CLASSIFICATION  OF  CLINIC  CASES       125 


morons,  who  can  do  fairly  complicated  work,  with  only 
occasional  supervision, — can  run  simple  machinery,  take 
care  of  animals,  only  are  unable  to  plan  anything."'^  This 
classification  further  elaborated  to  fit  every  age  of  child 
up  to  twelve  years  is  appended.  This  table  not  only 
carries  out  the  classification  to  its  logical  conclusion,  but 
at  the  same  time  roughly  correlates  it  with  the  Binet 
measuring  scale  of  intelligence. 

An  Industrial  Classification  Correlated  with  the  Binet 
Classification  Made  by  the  Vineland  Training  School, 
New  Jerjsey. 


Mental 

Age 

Under 

(a)  Helpless,     (b)  Can  walk,     (c) 

Low 

1  year 

With  voluntary  regard. 

1  year 

Feeds  self.    Eats  everything. 

Middle 

Idiot 

2  years 

Eats  discriminatingly. 

High 

3  years 

No  work.     Plays  a  little. 

4  years 

Tries  to  help. 

Low 

5  years 

Only  simplest  tasks. 

Middle 

Imbecile 

6  years 

lasks  of  short  duration.     Washes 
dishes. 

7  years 

Little  errands  in  the  house.    Dusts. 

High 

8  years 

Errands,  light  work.    Makes  beds. 

9  years 

Heavier    work.      Scrubs.      Mends. 
Lays  bricks.    Cares  for  bath-room. 

Low 

10  years 

Good  institution  helpers.     Routine 
work. 

Middle 

Moron 

11  years 

Fairly  compUcatcd  work  with  only 
occasional  oversight. 

12  years 

Uses  machinery.    Can  care  for  ani- 
mals.    No  supervision.     Cannot 
plan. 

High 

The  advantage  of  these  fuller  classifications  lies  in  the 
fact  that  they  offer  more  minute  possibilities  for  classifi- 

''  New  Jersey  Training  School  for  Feeble-minded  Boj-s  and  Girls, 
Twenty-second  Annual  Report,  1910,  pp.  136,  137. 


126     THE  CONSERVATION  OF  THE  CHILD 

cation,  and  therefore  come  nearer  to  the  true  state  of  the 

case,  namely,  that  no  such  sub-classification  actually  occurs 

,  in  nature.    While  it  is  practically  true,  as  has 

Advantage  of  , 

Fuller  ciassi-  bccn  notcd  abovc,  that  there  is  a  natural  and 

fication 

absolute  demarcation  between  the  normal  and 
the  ament,  when  the  process  of  definition  is  carried  further 
than  this,  it  is  doiie  for  the  purpose  of  study  and  conven- 
ience. The  truth  is,  that  degrees  of  mental  deficiency 
merge  gradually  from  one  into  the  other,  beginning  from 
the  highest  type  to  the  lowest.  That  is  to  say,  individ- 
uals can  be  actually  found  who  altogether  present  an 
indefinite  number  of  degrees  of  mentality,  and  no  sharp  or 
clear  lines  can  be  drawn  between  them.  All  that  we  can 
hope  to  do  is  to  mark  out  certain  distinctive  types,  to 
make  classifications  suitable  for  these  and  to  assign  others 
to  classes  according  to  their  approximation  to  the  average 
types. 

Barr's  Classification. — Finally,  we  offer  a  third  classi- 
fication made  by  Dr.  Barr.  It  is  called  educational,  in 
that  all  the  characteristics  of  its  several  divisions  are  the 
degrees  or  limits  to  which  the  mental  defectives,  included 
within  the  class,  can  be  educated.  It  is  therefore  practical 
and  useful  for  the  purpose  of  clinic  work,  since  the  prob- 
lem of  future  training  and  education  constitutes  a  very 
large  part  of  its  classification. 

The  scheme  of  classification  comprises  three  classes 
with  five  sub-classes  of  subnormals;  the  imbeciles  with 
the  three  sub-classes  of  high-grade,  middle-grade  and  low- 
grade;  the  idio-imbeciles,  and  the  idiots  sub-divided  into 
superficial  and  profound.  The  idiots  are  also  classified 
according  to  their  disposition  into  apathetic  and  excitable. 
These  various  classes,  together  with  their  capacities  for 
training  and  the  best  ultimate  disposal  to  be  made  of 
them,  are  given  as  follows: 


CLASSIFICATION  OF  CLINIC  CASES       127 


EDUCATIONAL  CLASSIFICATION  OF  THE 
FEEBLE-MINDED 


Idiot. 
Asylum  Care. 


Profound      {eL"}   Unimprovable 

„         _  .  ,    (Apathetic)    Improvable  in 
Superficial    JE^^i^^^^i^   ^^.j^.j^^^ip   ^,,1^^ 


Idio-Imbecile. 

Improvable  in  self-help  and  helpfulness. 
Trainable  in  very  limited  degree  to  assist  others. 

Imbecile. 
Long  Apprenticeship  and  Colony  Life  Under  Protection. 

Mentally  deficient. 

Low-Grade:  Trainable  in  industrial  and  simplest  man- 
ual occupations. 

Middle-Grade:  Trainable  in  manual  arts  and  simplest 
mental  acquirements. 

High-Grade:    Trainable  in  manual  and  intellectual  arts. 

Moral  Imbecile. 
Custodial  Life  and  Perpetual  Guardianship. 

Mentally  and  morally  deficient. 

Low-Grade:  Trainable  in  industrial  occupations;  tem- 
perament bestial. 

Middle-Grade:  Trainable  in  industrial  and  manual 
occupations;  a  plotter  of  mischief. 

High-Grade:  Trainable  in  manual  and  intellectual 
arts;  with  a  genius  for  evil. 


128     THE  CONSERVATION  OF  THE  CHILD 

Backward  or  Mentally  Feeble. 

Trained  for  a  Place  in  the  World. 

Mental  processes  normal,  but  slow  and  requiring  special 
training  and  environment  to  prevent  deterioration ;  defect 
imminent  under  slightest  provocation,  such  as  excitement, 
overstimulation  or  illness.'" 

A  Combination  of  Classifications. — The  oest  idea  of 
what  is  meant  by  mental  deficiency  in  general  and  by  each 
grade  of  deficiency  can  best  be  gained  by  a  study  of  several 
classifications  and  descriptions  massed  together  so  as  to 
show  their  similarities  and  differences.  For  this  purpose 
we  append  four  such  classifications  made  by  prominent 
authors  in  the  field. 

CLASSIFICATIONS 
Class  I,  By  Goddard.    Moron: 

1.  High-grade:  can  do  fairly  complicated  work  with 
only  occasional  or  no  supervision;  can  run  simple  machin- 
ery, take  care  of  animals;  only  unable  to  plan. 

2.  Middle-grade;  can  do  institution  routine  work. 

3.  Low-grade:  can  run  errands,  do  light  work,  make 
beds,  scrub,  care  for  rooms  if  there  is  no  great  complexity 
of  furniture. 

By  Barr.    Imbecile : 

1.  High-grade:  trainable  in  manual  and  intellectual 
arts. 

2.  Middle-grade:  trainable  in  manual  arts  and  simplest 
mental  acquirements. 

3.  Low-grade :  trainable  in  industrial  and  simplest  man- 
ual occupations. 

2"  Mental  Defectives,  Martin  W.  Barr,  1904,  P.  Blakiston's 
Sons  &  Co.,  Philadelphia,  p.  90. 


CLASSIFICATION  OF  CLINIC  CASES       129 

By  Binet.     Feeble-minded: 

Every  child  is  feeble-minded  who  knows  how  to  com- 
municate with  his  fellows  by  word  and  by  writing  but  who 
exhibits  a  retardation  of  two  or  three  years,  in  the  course 
of  his  studies,  unless  that  retardation  should  be  on 
account  of  insufficient  training. 

By  Tredgold.     Feeble-minded: 

L  First-grade:  can  make  tolerable  progress  in  element- 
ary school  work;  can  write  a  simple  letter,  read  children's 
books,  can  perform  simple  arithmetical  exercises  mentally. 
Can  do  good  manual  work. 

2.  Second-grade:  fall  considerably  behind  the  former  in 
purely  scholastic  attairmients,  and  also,  although  not  to 
the  same  extent,  in  handicraft.  Are  rarely  capable  of 
mental  and  seldom  of  paper  arithmetic,  and  their  read- 
ing and  writing  ability  extends  no  further  than  simple 
words  of  one  syllable.  Have  decidedly  less  general 
intelligence. 

3.  Third-grade:  form  a  connecting  link  with  the  imbe- 
ciles, from  whom  they  are  indeed  but  little  removed.  The 
improvement  effected  by  the  special  school  is  limited  to 
the  development  of  some  capacity  of  manual  work  under 
supervision,  and  to  the  formation  of  habits  of  obedience, 
tidiness  and  regularity.  Scholastic  acquirements  practi- 
cally nil. 

Class  II,  By  Goddard.     Imbecile: 

1.  High-grade:  can  do  tasks  of  short  duration  and  little 
errands  in  the  house, — washing  dishes,  scrubbing,  wash- 
ing and  sweeping,  perhaps. 

2.  Middle-grade:  can  do  simple  tasks,  very  simple 
indeed. 

9 


130     THE  CONSERVATION  OF  THE  CHILD 

3.  Low-grade:  plays  a  little  and  tries  to  help  but  can 
do  nothing  alone. 

By  Barr.     Idio-imbecile : 

L  Improvable  in  self-help  and  helpfulness. 

2.  Trainable  in  very  limited  degree  to  assist  others. 

By  Binet.     Imbecile: 

Every  child  is  an  imbecile  who  does  not  arrive  at  the 
ability  to  communicate  with  his  fellows  by  writing;  that 
is  to  say,  one  who  is  not  able  to  express  his  thoughts  in 
writing,  nor  to  read  writing  nor  printing,  or,  more  exactly, 
to  understand  what  he  writes;  when  neither  any  diffi- 
culty nor  motor-paralysis  of  the  arms  explains  the  non- 
acquisition  of  that  form  of  language,  but  the  fault  of 
acquisition  is  entirely  one  of  mental  deficiency.  A  child 
should  not  be  reckoned  an  imbecile  except  when  more 
than  the  usual  time  has  been  accorded  him  for  learning  to 
read  and  write.  The  usual  time  in  the  schools  is  about  six 
months,  and  a  child  who  has  been  in  school  for  about  two 
years  and  has  not  been  able  to  learn  his  letters  has  a  fair 
chance  of  remaining  an  imbecile. 

By  Tredgold.     Imbecile: 

Those  persons  who,  by  reason  of  mental  defect  existing 
from  birth  or  from  an  early  age,  are  incapable  of  earning 
their  own  living,  but  are  capable  of  guarding  themselves 
against  common  physical  dangers. 

Class  III,  By  Goddard.     Idiot: 

1.  High-grade:  the  child  who  eats  with  some  discrimi- 
nation, discarding  that  which  is  not  food. 


CLASSIFICATION  OF  CLINIC  CASES       131 

2.  Middle-grade:  the  one  who  is  able  to  feed  himself, 
but  who  eats  almost  anything. 

3.  Low-grade:  a  perfectly  helpless  child. 

By  Barr.     Idiot: 

1 .  Superficial :  improvable  in  self-help  only. 

2.  Profound .  unimprovable. 

ByTredgoId.     Idiot:   • 

1.  Partial  or  incomplete:  primitive  instincts  present; 
some  glimmer  of  the  mind  but  not  sufficient  intelligence 
to  understand  and  avoid  the  common  physical  dangers 
which  threaten  existence. 

2.  Complete,  absolute  or  profound:  defect  so  profound 
as  to  involve  the  fundamental  organic  instincts,  and  even 
that  of  sucking  is  absent. 

ByBinet.     Idiot: 

Every  child  is  an  idiot  who  does  not  arrive  at  the  ability 
to  communicate  by  word  with  his  fellows;  that  is  to  say, 
one  that  is  not  able  to  express  his  own  thoughts  verbally, 
nor  to  comprehend  the  thoughts  of  others  expressed  ver- 
bally; when  there  is  no  trouble  with  audition,  nor  any 
trouble  with  the  vocal  organs  to  explain  the  pseudo-apha- 
sia, which  is  due  entirely  to  deficiency  of  intellect.  If  it  is 
remembered  that  a  normal  child  of  two  years  should  be 
able  to  understand  the  talk  of  others  and  to  make  himself 
understood  by  others,  for  his  very  simple  needs,  it  is  easy 
to  make  the  distinction  between  the  idiot  and  the  normal. 

What  will  he  the  final  outcome  of  forming  classifications  ? 
Which  one  mill  be  adopted  ?  ^'ery  probably,  from  what 
has  already  been  intimated  regarding  the  flexibility  of  the 
three-fold  classification  which  gives  nine  sub-divisions,  that 


132     THE  CONSERVATION  OF  THE  CHILD 

one  will  be  the  one  eventually  most  acceptable  to  diagnos- 
ticians of  mental  deficiency.  The  simplicity  and  the 
symmetry  of  such  a  classification  will  make  its  appeal  to 
a  large  number  and  render  it  easier  and  quicker  of  appre- 
hension. However,  when  the  general  form  of  classifica- 
tion has  been  settled,  the  problem  of  sub-classification 
according  to  some  definite  principle  or  description  remains. 
For  example,  at  the  present  time  Dr.  Barr  classifies  accord- 
ing to  educational  standards,  Binet  according  to  speech 
ability,  Dr.  Tredgold  according  to  ability  to  hold  one's 
place  in  society,  to  care  for  one's  personal  affairs  with  pru- 
dence and  to  escape  common  dangers;  while  the  Vineland 
Training  School  classifies  according  to  industrial  capabil- 
ities. In  general,  however,  it  would  seem  that  all  sub- 
classifications  may  be  made  according  to  pedagogical  and 
sociological  principles.  The  work,  therefore,  to  be  done 
in  order  finally  to  fix  some  one  classification  and  make  it 
as  widely  acceptable  as  possible  is,  first,  to  find  by  investi- 
gation and  experimentation  the  pedagogical  possibilities 
of  each  sub-grade  of  the  mental  defective  and  then  by 
some  method  to  find  the  industrial  or  sociological  capabil- 
ities of  each  sub-division.  These  two  could  then  be  amal- 
gamated and  any  individual  could  be  classified  according 
to  his  intellectual  and  social  possibilities.  Such  a  task 
would  require  much  more  unity  and  cooperation  among 
the  many  workers  in  this  field  who  are  now  proceeding 
each  in  his  own  way  according  to  his  chosen  plan  without 
much  regard  to  what  is  being  done  by  others. 

A  Blended  Classification. — In  order  to  give  a  brief 
hint  as  to  how  this  can  be  done  and  also  to  furnish  the 
practical  student  with  a  composite  description  of  the 
various  grades  of  aments,  four  classifications  used  by 
prominent  authors  have  been  brought  together  side  by 
side  and  are  given  above. 


A  liijih-gradc  mnidii.     \'it\' 
deaf. 


A  t\velvo-ycar-ol(l  lii,irli-g.rai!e 
imbecile  sulTering  from  mal- 
nutrition. 


lIit;;li-ftra(lo    imbecile.      Much  A   lii^h-ui...;.     .n,!.,.,!,.      Ten 

more  capable  than  her  appear-        years  old.       Less   cajiabU^   than 
ance  indicates.  her  appearance  indicates. 


VI 

METHOD  OF  CLASSIFYING  CLINIC  CASES 

In  the  precedinf^  chapter  the  classification  of  mental 
defectives  has  been  considered  in  general.  The  meanings 
of  backwardness  and  mental  deficiency  were  discussed 
and  the  primary  problem  of  clinical,  mental  classification 
was  shown  to  be  the  differentiation  between  the  two.  It 
was  proposed  that  curability  and  incurability  be  accepted 
as  the  basis  for  classifying  all  mental  and  moral  deviates 
respectively,  and  several  systems  of  classification  in  com- 
mon use  were  given  ^vith  synoptic  descriptions  of  their 
sub-classes. 

We  now  turn  to  that  other  phase  of  classification  which 
concerns  itself  with  the  process  of  measuring  mental 
status  by  means  of  questions,  tests  and  observations.  Into 
a  somewhat  detailed  description  of  this  process  we  will 
enter,  giving  at  the  same  time  the  reasons  for  asking  the 
questions  asked  and  for  making  the  tests  made. 

First  Steps  in  Making  a  Diagnosis. — When  the 
cliniciaii  is  brought  face  to  face  with  the  child  to  be  classi- 
fied, he  first  proceeds  to  get  the  case  in  hand  by  asking  a 
few  preliminary  questions  which  settle  immediately  the 
kind  of  deviation  with  which  he  has  to  deal.  It  may  be 
mental  or  moral  or  a  combination  of  both.  In  every  case 
the  problem  and  the  method  of  mental  diagnosis,  though 
not  of  training,  is  the  same.  Let  us  say,  it  is  simple 
mental  deviation.  Another  question  or  two  reveals  that 
it  is  a  case  of  retardation  in  school  work.  Suppose  the 
boy  is  ten  years  old  and  only  in  the  second  gratle.  Wlien 
this  much  is  clear,  the  next  step  is  to  determine  whether 

133 


134     THE  CONSERVATION  OF  THE  CHILD 

the  stated  retardation  is  curable  or  incurable.  This  is 
the  critical  though  not  final  step  in  the  whole  process, 
and  upon  it  depend  not  only  the  other  later  steps  of 
diagnosis  but  also  the  training  of  the  child.  Surrounding 
it  are  all  the  practical  difficulties  hinted  at  in  the  previous 
chapter;  difficulties  not  yet  removed  by  the  most  elaborate 
schemes  and  which  require  the  skill  and  long  experience 
of  an  expert  to  remove  them.  The  larger  the  number  of 
tests  brought  to  bear  and  the  greater  the  opportunity  of 
the  examiner  to  study  not  only  the  child  but  all  the 
influences  having  a  bearing  upon  his  condition,  the  more 
certain  the  results  will  be. 

The  Search  for  Causes. — In  general  the  process  is 
simple  enough.  It  seeks  to  discover  underlying  causes, 
correlates  or  concomitants  which,  by  experience,  have 
been  found  to  accompany  one  form  or  the  other  of  retarda- 
tion. They  are  to  be  found  within  or  without  the  child 
himself.  If  without,  they  are  pedagogical  or  sociological; 
if  within,  anatomical,  physiological,  or  psychological. 
They  may  be  further  classified  chronologically  as  pre- 
natal, natal,  and  post-natal.  In  all  cases  some  are  patently 
removable;  some  are  irremovable.  Some,  too,  are  invari- 
ably correlated  with  incurable  mental  defects;  others  are 
not,  and  still  others  sometimes  are  and  sometimes  not. 
The  process  of  mental  diagnosis,  then,  resolves  itself  into 
a  search  for  correlates  which  by  their  nature  determine 
the  curability  or  incurability  of  the  mental  or  moral 
deviation. 

Theoretically,  the  best  way  to  accomplish  this  would 
be  by  a  direct  examination  of  the  child's  nervous  anatomy. 
If,  for  example,  the  non-development  of  a  cerebral  lobe, 
or  scar-tissue  from  previous  meningitis,  could  be  dis- 
covered, the  prognosis  would  be  immediate  and  final.    In 


CLASSIFYING  CLINIC  CASES  135 

some  cases  the  required  evidence  can  be  obtained  by- 
direct  inspection  of  the  nervous  system.  Wherever  end- 
organs  of  sense  have  been  irretrievably  destroyed  at  an 
early  age  the  corresponding  cerebral  centres,  both  primary 
and  secondary,  must  of  necessity  suffer  a  permanent 
cessation  of  development,  and,  hence,  imbecility  or 
"idiocy  by  deprivation,"  as  it  is  called,  must  result.  Such 
a  state  is  recognized  by  writers  upon  idiocy.  Dr.  Barr 
mentions  it  as  one  common  with  deaf-mutes. 

"Before  leaving  the  subject  of  etiology,"  he  says,  "it 
seems  fitting  to  mention,  however  briefly,  'idiocy  by 
deprivation.'  As  has  already  been  noted,  many  causes 
may  be  resolved  into  the  single  one  of  malnutrition,  and 
may  be  traced  in  mental  as  well  as  in  physical  conditions. 
The  lack  or  loss  of  any  one  sense  avenue  will  preclude  or 
arrest  the  development  more  directly  dependent  upon 
that  one  avenue,  and  the  mind  suffer  a  certain  starvation, 
so  to  speak,  as  in  the  case  of  the  blind  or  the  deaf- 
mutism  })eing  an  acknowledged  example.  True  it  is  that 
other  senses  may  be  so  aroused  as  to  counterbalance  or 
supply  the  loss  of  the  one,  but  when  there  is  lack  of  nerve 
force  from  weakness  engendered  b}^  causes  either  con- 
genital or  accidental  this  fails,  and  'idiocy  by  depriva- 
tion' ensues.  Such  cases  are  to  be  encountered  from  time 
to  time  in  most  institutions  for  the  blind  and  deaf-mutes."' 

The  Case  of  Helen  Keller. — Some  such  instances  of 
amentia,  though  thoroughly  in  accord  with  the  scientific 
classification  by  incurable  causes,  furnish  striking  excep- 
tions to  the  popular  conceptions  of  idiocy.  No  ordinary 
layman  would  think  of  Helen  Keller  as  mentally  defective 
or  an  imbecile.     Yet,  strictly  speaking,  in  spite  of  her 

1  Mental  Defectives,  Martin  W.  Barr,  1904,  pp.  120,  121. 


136     THE  CONSERVATION  OF  THE  CHILD 

acquisition  of  French,  German,  Latin,  and  Greek,  her 
early  admission  to  and  successful  graduation  from  college, 
and  her  later  relatively  brilliant  intellectual  performances, 
she  is  and  must  always  remain  a  mental  defective.  For 
she  early  suffered  the  permanent  loss  of  hearing  and  eye- 
sight, and  no  amount  of  training  has  been  able  to  wholly 
overcome  the  loss.  Color  and  sound  to  her  must  ever 
remain  unknown  and  unknowable  sensations.  Her  visual 
and  auditory  centres  have  remained  unstimulated  through 
long  years,  and,  like  all  other  unused  organs,  have  not 
been  developed  and  cannot  be.  Had  it  not  been  for  the 
labors  of  Pereire  with  deaf-mutes,  she  might  have  remained 
dumb  and  all  that  opportunity  for  self-expression  through 
speech  would  have  been  cut  off  and  profounder  idiocy 
resulted.  Such  examples  are  illuminating  both  to  point 
out  clearly  the  meaning  of  and  also  to  illustrate  the  theo- 
retical method  for  the  discovery  of  mental  deficiency. 

The  Case  of  Kaspar  Hauser. — A  case  less  famous 
than  that  of  Helen  Keller,  which  presents  an  incurable 
retardation  on  account  of  isolation  from  society,  is  that 
of  Kaspar  Hauser.  He  suffered  from  almost  complete 
mental  retardation  due  to  the  non-development  of  his 
brain  on  account  of  confinement  from  his  earliest  memories 
in  an  underground  dungeon.  When  about  seventeen 
years  of  age  he  was  found  wandering  about  the  city  gate 
of  Nuremberg,  Germany.  He  could  give  only  his  name 
and  utter  one  sentence,  "I  will  be  a  trooper  as  my  father 
was."  His  education  was  undertaken  by  Prof.  Daumer. 
His  avidity  for  knowledge  in  all  forms  was  wonderful.  He 
learned  rapidly  and  seemingly  assimilated  what  he  learned. 
However,  possibly  due  to  overtraining,  he  broke  down 
and  for  a  time  his  education  had  to  be  discontinued. 

It  was  found  that  he  had  a  remarkable  faculty  for  smell 


CLASSIFYING  CLINIC  CASES  137 

and  for  seeing  things  in  the  dark.  This  was  attributed 
to  the  fact,  which  he  stated  after  he  learned  to  talk,  that 
he  had  always  lived  continually  seated  on  the  ground  in 
a  small,  dark  cell.  He  had  never  seen  the  sky  nor  a  human 
face,  but  was  accustomed  to  find  some  bread  and  a  pitcher 
of  water  near  him  when  he  awoke.  The  man  who  placed 
it  there  taught  him  to  write  his  own  name  and  to  speak 
one  sentence  and  finally  brought  him  to  Nuremberg  gate. 
For  a  time  his  mental  development  proceeded  with  extreme 
rapidity.  But  his  long  isolation  and  constant  lack  of 
training  and  opportunity  for  learning  had  wrought  an 
incurable  effect  upon  his  brain.  After  a  time  he  could 
make  no  further  progress.  In  1833  he  met  his  death, 
which  was  as  tragic  and  mj'^sterious  as  were  his  birth  and 
life.  By  appointment  he  met  a  stranger  in  a  public  park 
who  had  promised  to  clear  up  tlu;  mystery  of  his  birth. 
During  the  interview  Hauser  received  a  stab  wound  from 
which  he  died  three  days  later.  The  autopsy  showed  a 
somewhat  thickened  skull  and  a  rather  small  brain  which 
did  not  completely  cover  the  cerebellum,  with  convolu- 
tions smaller  than  the  normal.  On  the  whole,  it  would 
seem,  despite  the  many  contradictions,  that  his  story  was 
true,  and  that  he  presents  an  unique  case  of  incurable 
retardation  due  to  lack  of  training. 

In  the  vast  majority  of  cases  presented  at  the  clinic,  the 
diagnosis  is  not  arrived  at  by  the  direct  observation  of  im- 
mediate causes.  They  must  be  discovered  by  more  indirect 
processes.  Remembering  that  the  purpose  of  all  inquiries 
and  all  tests  is  first  to  decide  upon  the  curability  or  in- 
curability of  the  deviation,  and  ultimatel}'  upon  the  degree 
of  either  retardation  or  intelligence,  the  clinician  proceeds 
to  rough-hew  his  case;  first  by  securing  oral  information 
upon  the  personal  and  family  history  of  the  child.    Next 


138     THE  CONSERVATION  OF  THE  CHILD 

he  makes  a  physical  examination  to  corroborate  or  to 
dispel  suspicions  aroused  by  the  family  history,  and  lastly 
he  comes  to  the  mental  test  proper  which  will  not  only 
decide  the  degree  of  mental  deviation,  but  also  locate  the 
mental  defect  either  in  general  mental  arrest  or  in  some 
particular  mental  process  like  perception,  memory  or 
reason.  This,  in  brief,  is  a  bird's-eye  view  of  the  whole 
procedure.  It  now  remains  to  take  up  each  process  more 
in  detail. 

Causes  of  Pedagogical  Retardation. — The  first  step 
is  to  secure  information  on  all  those  factors  having  a 
possible  bearing  upon  the  child's  present  condition  which 
have  acted  upon  him  from  the  present  moment  back  to 
the  hour  of  his  birth  and  beyond  even  to  those  pre-natal 
and  hereditary  influences  that  play  such  a  peculiar  and 
such  a  prominent  part  in  determining  the  mentality  of 
the  feeble-minded.  Assuming,  as  we  did  above,  that  our 
hypothetical  case  is  discovered  to  be  one  of  school  retarda- 
tion, the  first  inquiries,  after  questions  of  age  and  school 
grade,  will  seek  to  discover  or  to  eliminate  certain  pos- 
sible causes  of  this  retardation.  For  instance,  he  may 
have  started  to  school  at  a  late  age,  or  attended  irregularly. 
Either  fact  may  account  for  his  retardation.  To  carry 
on  our  illustration,  however,  let  us  assume  that  he  did 
start  at  the  usual  time  and  attended  regularly.  This  at 
once  establishes  a  presumption  in  favor  of  some  peculiarity 
in  the  child.  For  the  majority  of  the  children  under  the 
same  circumstances  make  better  intellectual  progress. 
Measured  by  usual  school  standards,  he  should  be  in  the 
fourth  instead  of  the  second  grade.  His  backwardness 
must  be  due  to  his  inability  or  unwilHngness  to  learn. 
If  his  general  conduct  is  good  and  his  teachers  and  parents 
testify  to  his  willingness  to  do  all  he  can,  another  possi- 


CLASSIFYING  CLINIC  CASES  139 

bility  is  eliminated  and  the  case  is  narrowed  down  to 
simple  mental  deviation  characterized  by  retardation  in 
school  work. 

The  Personal  History  of  the  Child. — Still  in  search 
of  the  factors  contributing  to  this  situation,  the  examiner 
begins  a  careful  inquiry  into  the  personal  history  of  the 
child  to  learn  of  any  disea.ses  or  accidents  which  would 
confirm  the  suspicion  of  a  mental  defect  manifested  by 
the  scholastic  backwardness.  He  may  or  may  not  find 
anything  conclusive.  In  this  case,  we  will  assume  that 
a  history  of  spasms,  slowness  in  walking  and  talking,  and 
later  a  blow  on  the  head,  are  developed.  The  spasms 
ceased  at  three  years  of  age  and  the  blow  was  not  severe 
enough  to  produce  unconsciousness  nor  to  leave  a  scar, 
liowever  much  impression  it  may  have  left  upon  the 
parents'  memories. 

The  Family  History.— Thereupon  the  clinician  takes 
up  the  family  history  proper,  at  once  the  most  important 
and  the  most  delicate  task  in  his  preliminary  inquiry. 
The  story  of  early  spasms  in  the  child's  personal  history 
has  prepared  the  examiner's  mind  for  some  neurosis  in 
the  famil3\  By  dint  of  questioning  he  uncovers  a  case  of 
extreme  "nervousness"  in  an  aunt  who  was  never  in  an 
insane  asylum  but  was  very  "queer"  in  her  talk  and 
actions.  This  in  turn  is  connected  with  jwssibly  some 
erratic  conduct  and  queer  notions  of  a  grandparent, 
though,  as  far  as  can  be  learned,  nothing  else  significant 
appears.  If  insanity,  epilepsy,  or  imbecility  did  appear 
in  either  parent  of  the  boy,  this,  taken  with  his  own 
mental  retardation,  would  make  the  evidence  of  his  incura- 
bility almost  conclusive. 

Individual  and  Social  Capacities. — After  the  family 
history  is  learned,  a  series  of  questions  are  asked  concern- 


140     THE  CONSERVATION  OF  THE  CHILD 

ing  the  boj^'s  individual  and  social  capacities.  They  are 
similar  in  their  intent  to  the  pedagogical  questions,  but 
deal  with  more  fundamental  capacities,  like  the  instincts 
and  emotions.    All  of  the  questions  are  given  below. 


Case. 


GENERAL  EXAMINATION 
Made  by 


Date 

Notes  by 

Name 

Age 

Address 

Pedagogical  History: 

1.  What  is  your  name?    (Child,  parent.) 

2.  Why  do  you  bring  this  child  ? 

3.  Did  any  one  suggest  that  you  come  here? 

4.  Have  you  ever  been  here  before? 

5.  How  old  is  the  child  ?    Birthday? 

6.  Does  he  go   to  school  ?     Kindergarten?     Public? 

Private?    Parochial  ? 

7.  What  grade  is  he  in? 

8.  At  what  age  did  he  start  to  school  ? 

9.  Does  he  get  along  well  in  school  ?   In  what  branches? 
10.  Has  he  always  been  promoted  ?    If  not   why  ?  On 

account  of  irregular  attendance  ? Or  in- 
ability to  learn  ? Or  conduct  ? 


CLASSIFYING  CLINIC  CASES  141 

Past  Medical  History: 

1 1 .  Has  ho  been  ill  since  he  started  to  school  ?    With 

what  diseases? 

12.  Before  he  started  to  school  did  he  have  any  of  the 

usual  children's  diseases?  Measles?  Chicken- 
pox?  Mumps?  Whooping-cough?  Diphtheria? 
Scarlet  fever?  Meningitis?  Marasmus?  Any- 
special  troubles?    Any  falls?    Injuries? 

Babyhood : 

13.  When  did  he  begin  to  walk? 

14.  When  did  he  begin  to  talk? 

15.  When  did  the  first  tooth  come? 

16.  When  did  he  sit  up? 

17.  Did  he  grasp  toys?    Go  after  toys? 

18.  Did     he     have     any    infant     troubles?      Summer 

complaint  ? Serious  falls? Serious  in- 
juries?   Convulsions? Spasms? 

Indigestion? 

Birth: 

19.  Was    he    born    naturally?      At   full    time?      With 

instruments?  Was  he  a  large  baby?  What  was 
his  weight  at  birth?  Was  he  a  "blue"  baby? 
Did  he  cry  immediately?  Did  he  suckle  immedi- 
ately? Was  he  fed  by  bottle?  On  prepared  food  ? 
Did  he  cry  much  during  infancy?  Did  he  sleep 
well  ?  Did  he  get  thin?  Have  you  noticed  any 
difference  between  him  and  your  other  children? 

Family  History: 

20.  How  many  children  have  you?     Were  there  any 

miscarriages? 


142     THE  CONSERVATION  OF  THE  CHILD 

21.  How  many  living?    How  many  dead?    With  what 

did  each  die? 

22.  What  is  the  age  of  each  Hving  child?    Which  child 

is  this? 

23.  Are  the  other  children  doing  well  at  school  ? 

24.  Are  they  all  normal  and  healthy,  physically  and 

mentally? 

Mother's  History: 

25.  Does  this  child  look  like  his  mother?    Is  the  mother 

in  good  health  now?  Has  she  always  been  in 
good  health?  Was  she  so  just  before  the  birth 
of  the  child  ?  At  the  time  was  she  taking  any 
medicine?  Did  a  physician  attend  her  for  any 
illness  just  before  this  child's  birth?  Did  she 
work?  At  home?  Away  from  home?  How  old 
was  she  when  this  child  was  born?  Did  she  at 
that  time  have  any  falls  or  injuries  of  any  kind? 
Does  she  use  intoxicants?  Of  what  nationahty 
is  she?    Where  born? 

Mother's  Father: 

26.  Is  the  mother's  father  living?    Of  what  did  he  die? 

27.  Was  he  a  healthy,  normal  man?     Did  he  always 

work?    What  did  he  do? 

28.  Were  his  brothers  healthy,  normal  men?     Sisters 

healthy  and  normal  ? 

Mother's  Mother: 

29.  Is  the  mother's  mother  living?     If  dead,  of  what 

did  she  die? 

30.  Was  she  always  normal  and  healthy?    How  many 

children  had  she?  Are  all  of  them  well  and 
normal  ? 


I 


CLASSIFYING  CLINIC  CASES  143 

31.  Are   there    any    abnormalities    whatever    amongst 

mother's  relatives? 

32.  Are  this  child's  uncles  and  aunts  normal  ? 

33.  Are  this  child's  cousins  normal  ? 

Father's  History: 

34.  Does  this  child  look  like  his  father? 

35.  Is  the  father  living? 

36.  How  old  is  he?     Has  he  always  been  healthy  and 

normal  ? 

37.  What  diseases  has  he  had?     Any  injuries?    Ever 

been  in  the  hospital  ?  Has  he  ever  had  any  opera- 
tions?   Any  running  sores? 

38.  Does  he  drink  intoxicants?    Of  what  nationality  is 

he?    Where  born? 

39.  What  is  his  occupation?     Does  he  work  steadily? 

Why  is  he  out  of  work?  How  much  education 
has  he  had  ?  In  what  grade  of  public  school  was 
he  last? 

40.  Was  he  married  before?    Of  what  did  his  first  wife 

die? 

Father's  Father: 

41.  Is  the  father's  father  living?    If  so,  how  old  is  he? 

If  dead,  of  what  did  he  die?  Was  he  always 
normal  and  in  good  health?  Did  he  work? 
Regularly?  How  long  did  he  stop  work  before 
he  died  ?  Were  his  brothers  normal,  healthy  men? 
Were  his  sisters  normal  and  healthy? 

Father's  Mother: 

42.  Is  father's  mother  living?     How  old  is  she?     If 

dead,  of  what  did  she  die?  Was  she  always 
healthy  and  normal?  How  many  children  did 
she  have?    Are  they  all  well  and  normal? 


144     THE  CONSERVATION  OF  THE  CHILD 

43.  Are  there  any  abnormalities  amongst  the  father's 
relatives?    Are  any  dead  ?    Of  what  did  they  die? 
General  Remarks. 

I.  Personal  Capacities: 

1.  Can  this   child  feed   himself?     Eat  at  the  table? 

Handle  a  knife?  fork?  spoon?    Eat  what  the  rest 
of  the  family  eats  ?    Will  he  eat  what  is  not  food? 
Does  he  bolt  his  food  ?    Is  he  a  glutton? 
Remarks: 

2.  Does  he  dress  himself  ?    Button  clothes?  lace  shoes? 

tie  shoe  strings,  etc.? 
Remarks: 

3.  Does  he  wash  his  own  face?  comb  hair?  bathe  him- 

self ?  clean  his  teeth? 
Remarks: 

4.  Does  he  attend  to  his  wants  by  himself  ?    Wet  the 

bed  ?    Soil  his  clothes  during  the  day? 
Remarks: 

5.  Can  he  walk?   Is  his  gait  normal?   Energetic?   Slow? 

Shuffling? 
Remarks: 

6.  Other  individual  traits? 

II.  Social  Capacities: 

1.  Can    he    guard    himself    against    common    danger? 
Falls?    Accidents?  Burns?  Can  he  go  alone  on  the 
street  ? 
Remarks: 


CLASSIFYING  CLINIC  CASES  145 

2.  Can  he  talk?    In  monosyllables  only?    Use  sentences? 

Fluent?  Talkative?  Taciturn?  Intelligent  con- 
versation? Mute?  Make  wants  known  by  signs? 
Gestures?  Stutter?  Stammer  (baby  talk)? 
(Mark  articulation  defects  on  proper  report  blanks.) 
Verbigerate?  Echolalia?  Does  he  sing? 
Remarks: 

3.  Is  he  sociable?     Does  he  play  with  others?     Same 

age?    What  games  does  he  play? 

(a)  Toys,  hobby  horses,  locomotives,  wagons,  shovels, 
sand-piles,  dolls,  etc. 

(b)  Tag,  hide-and-go-seek,  cops  and  robbers,  wooden 
guns,  swords,  knives,  bows,  marbles,  ball,  etc. 

(c)  Athletic  contests,  play  on  teams?     Base  ball, 
basket  ball,  etc.? 

(d)  Does  he  play  any  musical  instruments?    Sing? 

III.  Moral  Capacities: 

1.  Is  he  obedient  ?  Play  truant  ?   Lie?   Smoke?  Swear? 

Steal  ?    Sexual  vices? 

2.  Has  he  ever  been  suspended  from  school  ?    Arrested  ? 

House  of  Detention?    Reformatory? 

3.  Does  he  know  right  from  WTong? 

4.  Does  he  attend  Sunday  School  ? 

5.  Describe  minutely  concrete  instances  of  his  immoral 

actions. 

IV.  Industrial  Capacities: 

1.  Does  he  work?    What  does  he  do?    Has  he  worked 

there  long?    How  many  positions  has  he  had  ? 

2.  Can  he  tie  knots?    Thread  needle?    Sew?    Knit  ? 

10 


146     THE  CONSERVATION  OF  THE  CHILD 

3.  Do    housework?     Wash    dishes?     Sweep?     Cook? 

Make  beds?     Can  he  be  trusted  to  do  these  by 
himself? 

4.  Can  he  use  tools?    Saw?    Hammer?    Make  wagons? 

Kites,  etc.? 

5.  Can  he  do  errands  ?    Go  to  store  ?    Remember  things 

to  be  brought?    Get  right  change? 

6.  What  can  he  do  best?    What  does  he  want  to  work 

at  when  he  grows  up  ? 
Remarks: 

The  Questions  Explained. — The  order  of  the  questions 
has  already  been  referred  to  and  the  reason  for  this  order 
explained.  Several  other  characteristics  in  the  questions 
are  to  be  noted.  They  are  not  merely  formal;  each  has 
its  purpose;  each  is  expected  directly  or  indirectly  to 
elicit  some  information.  They  are  worded,  therefore,  so 
as  to  be  comprehended  by  the  ordinary  clinic  visitor. 
Many  of  them  are  so  phrased  as  to  hide  their  real  purpose 
and  to  secure  admissions  the  meaning  of  which  is  unknown 
to  the  respondent  but  clear  to  the  interrogator. 

For  example,  the  second  query  will  reveal  the  class  of 
deviates  to  which  the  child  belongs,  whether  he  is  a 
mental  or  moral  deviate,  or  both.  With  school  children 
the  innocent  questions  of  age  and  school  grade  will  ehcit 
the  necessary  information  as  to  pedagogical  retardation. 
When  this  much  is  clear,  the  case  is  before  the  examiner 
and  he  then  begins  a  search  for  causes.  Questions  8,  9, 
10  and  11  seek  to  locate  the  causes  of  backwardness,  if  it 
is  present,  in  the  child  or  in  his  environment.  Question 
12  examines  his  diseases;  questions  13  to  19  seek  more 
information  into  causes,  and  the  remainder  delve  into  the 
family  history. 


CLASSIFYING  CLINIC  CASES  147 

It  is  not  expected  that  they  will  be  slavishly  adhered 
to,  but  are  to  be  varied  as  occasion  may  demand.  Since, 
however,  the  questions  have  been  A\Tought  out  of  actual 
experience,  it  "will  be  frequently  found  that  their  form,  as 
well  as  their  order,  has  its  value  in  performing  a  necessary 
and  difficult  task,  viz.:  eliciting  necessary  information 
from  uncertain,  halting  and  half- willing  persons  on  a 
subject  hard  to  discuss  freely.  Incidentally,  they  serve  a 
double  secondary  purpose.  They  draw  out  the  naturally 
taciturn,  but  tend  to  quench  the  voluble  irrelevancy  of  the 
garrulous. 

The  Physical  Examination. — After  the  oral  examina- 
tion has  been  completed  a  physical  examination  of  the 
child  is  made  by  a  medical  attendant  at  the  Psychological 
Clinic.  The  nature  and  purpose  of  this  examination  must 
be  carefully  considered. 

First,  it  must  be  clearly  understood  that  the  ph3'sical 
examination,  though  usually  made  by  a  medical  man  and 
taking  cognizance  of  all  anatomical  and  physiological 
derangements,  is  in  no  wise  a  medical  diagnosis.  For 
that  purpose  the  children  are  sent  to  physicians,  specialists, 
or  medical  clinics. 

The  -physical  examination  at  the  Psychological  Clinic  is 
definitely  divided  into  two  parts.  The  first  is  a  complete 
anthropometric  measurement  of  the  child,  together  with 
a  description  of  his  general  physical  appearance,  muscular 
coordination,  gait,  posture,  and  physical  tone.  The 
second  part  consists  of  an  extensive  medical  examination, 
comprising,  as  far  as  circumstances  will  allow,  a  more  or 
less  minute  scrutiny  of  all  organs  and  all  symptoms  of 
physical  derangement.  This  divides  the  phj^sical  examina- 
tion into  five  parts.  Part  I  is  anthropometrical,  static 
and  dynamic;  Part  II  is  medical,  local,  constitutional, 


148     THE  CONSERVATION  OF  THE  CHILD 

and  nervous.  This  arrangement  is  made  primarily  to 
facilitate  clinic  procedure  by  permitting  one  assistant  to 
make  the  anthropometric  measurement  while  the  medical 
assistant  may  be  working  with  another  case.  The  exami- 
nation blank  used  is  appended  for  closer  consideration. 

PHYSICAL  EXAMINATION 
I.  Anthropometric  Measurements: 
A .  Static  Measurements: 

1.  General  Appearance. 

2.  Posture. 

3.  Gait. 

4.  Height. 

5.  Weight. 

(  Girth. 

6.  Head  Measurements <  ^    •  •-  i     r      j.  i 

j  Occipital — frontal. 

(  Occipital — mental. 

7.  Cephalic  Index. 

8.  Stigmata  and  Abnormahties : 

Skin:    Rough,  smooth,  clean,  pediculi. 

Hair:  Rough,  smooth,  soft,  bristly,  color,  sparse, 
thick  low-growing. 

Head:  Rachitic,  dolicocephalic,  brachycephahc, 
microcephalic,  hydrocephalic,  scars,  protuber- 
ances. 

Forehead     Receding,  low,  high,  narrow. 

Ears:  Small,  large,  infantile,  pointed.  Darwinian, 
tubercle,  lobe,  helix,  antihehx. 

Nose:    Bridge,  alae.  nares. 

Throat:  Tonsils,  hypertrophic,  atrophic,  sub- 
merged. 


CLASSIFYING  CLINIC  CASES  149 

Teeth:     Irregular,    Hutchinson,    pegged,    tartar, 

caries,  lacking. 
Palate:    High,  narrow,  broad. 
Tongue:    Color,  coating,  fissures. 
Glands:    Cervical,  saUvary. 
Eyes:    Color,  infantile,  large,  small,  narrow-set, 

broad-set,  epicanthus. 


(    .  ,  ^  f  cervical. 


Trunk  and  Limbs:    Scoliosis  ,  ,  T*.     -{  dorsal. 

^  ( lumbar. 

(    .  ,     {  cervical. 
I  right  J 


Lordosis  ^  ,  r .     \  dorsal. 
^  ( lumbar. 

Shoulder  Blades :    Prominent. 
Hands:    Moist,  dry,  cyanosed. 
Feet:    Flat,  clubbed. 

B.  Dynamic  Measurements: 

\.  Chest  Expansion:  .  ^^    ' 
[^  lower. 

2.  Dynamometer:  <    .  ,  ,  ,      ", 

(  right  hand. 

„    -^  ,1  left  hand. 

3.  Ergograph:  \    .  ,  ,  ,       , 

(  right  hand. 

4.  Vital  Capacity  or  Coefficient  =  R.  H.  C.XO  S.  H.  C. 

II.  Medical  Examination: 

A.  Local: 

(  Irregular. 
1.  Heart  :<  Intermittent. 
(  ^lurmurs. 


150     THE  CONSERVATION  OF  THE  CHILD 

f  Inspiratory  sound. 
■  )  Expiratory  sound. 

r  Normal. 

3.  Stomach :  <  Distended. 

(^  Ptosis. 

r  Normal. 

4.  Intestines:  <  Distended. 

(  Meteorisra. 

(  Normal. 

5.  Liver:  <  Enlarged. 

\  Atrophy. 

^  .  ,  (  Normal. 

6.  Kidneys:|p^^^j^_ 

7.  Bladder:    Incontinence. 

r  Circumcision  needed. 

8.  Genitaha:    <  Hymen  intact. 

(^  Hymen  ruptured. 

(  Myopia. 

9.  Vision:    <  Hyperopia. 

I  Strabismus. 

(  Watch  test. 

10.  Audition  :<  Whisper  test. 

(  Audiometer. 

B.  Constitutional  or  Diathetic: 

Anaemia. 

Rheumatism. 

Syphilitic. 

Chlorose. 

Rachitic. 

Tubercular. 


CLASSIFYING  CLINIC  CASES  151 

C.  Nervous  Diseases: 

Chorea. 

Convulsions. 

Epilepsy. 

Hysteria. 

Insanity. 

Meningitis. 

Myelitis. 

Paralyses. 

The  purpose  of  the  physical  examination  in  a  mental 
diagfiosis  is  not  to  discover  anatomical  or  physiological 
causes  of  mental  deficiency.  We  have  carefully  avoided 
that  conception  for  several  reasons.  First,  the  assumption 
of  a  physical  cause,  for  example,  a  cerebral  lesion,  for 
every  case  of  mental  deficiency,  is,  to  say  the  least,  un- 
necessary. It  does  not  assist  in  the  solution,  but  adds 
another  confusing  factor  as  difficult  to  discover  or  to 
infer  as  is  the  mental  defect  for  the  explanation  of  which 
it  is  invoked.  Secondly,  it  involves  an  assumption  of  a 
causal  nexus  between  the  physical  and  the  psychical, 
which  is  by  no  means  universally  admitted. 

That  there  is  a  relation  of  some  kind  no  one  pretends 
to  deny.  And  this  relation,  which  is  the  foundation  of  all 
physiological-psycholog}',  not  only  justifies  but  makes 
indispensable  in  every  classification  of  mental  or  moral 
deviation  a  physical  examination  of  the  most  complete 
kind  possible.  It  is  not,  however,  a  relation  that  would 
justify  the  psychologist  in  bending  all  his  efforts  toward 
locating  a  cerebral  defect  and  then  arguing  from  the  brain 
defect  that  an  incurable  mental  aberration  is  consequently 
present. 

As  has  already  been  said,  cerebral  defects  are  too  obscure 


152     THE  CONSERVATION  OF  THE  CHILD 

and  too  difficult  to  discover  to  be  diagnosed  by  the  psy- 
chologist. The  only  persons  equipped  at  the  present 
time  to  do  this  are  the  specialists  in  neurology.  And  it 
is  for  this  purpose  of  deciding  whether  the  child  must  be 
referred  to  a  specialist  that  the  physical  examination  is 

made. 

Two  Kinds  of  Physical  Defects. — The  psychologist 
also  seeks  to  corroborate  his  suspicion  of  mental  deficiency 
founded  upon  the  oral  examination  into  the  personal  and 
family  history  of  the  child  and  to  secure  new  evidence 
pro  and  con  by  seeking  for  two  kinds  of  physical  defects 
in  the  child.  The  defects  of  one  class  are  by  their  very 
nature  patently  removable.  Those  of  the  other  class  are 
congenital  and  irremovable  and  are  commonly  called 
stigmata  of  degeneration.  The  first  may  in  no  wise  affect 
brain  structure  or  brain  development,  but  they  may  be 
sources  of  constant  irritation  and  hence  play  a  most 
important  part  in  retardation  by  giving  rise  to  flighty 
attention,  as  frequently  happens  in  cases  of  hypertrophied 
adenoids,  or  unruly  behavior,  as  sometimes  happens  in 
cases  of  impacted  dentition.  They  may  therefore  explain 
any  particular  case  of  pedagogical  retardation  like  the 
one  we  are  supposed  to  be  examining.  Dull  hearing,  poor 
vision,  hypertrophied  faucial  and  pharyngeal  tonsils, 
irregular,  non-occluding,  decaying  teeth, — one  or  all  of 
these  apparently  simple  physical  defects  may,  and 
frequently  do,  produce  a  cHnical  picture  of  mental 
deviation  impossible  to  distinguish  from  the  clinical 
pictures  of  incurable  mental  deficiency  by  physical  or 
mental  tests. 

If  the  clinician  is  presented  with  such  a  case  two  courses 
are  open  to  him.  He  may  fall  back  upon  the  personal  or 
family  history  already  obtained,  and  be  determined  in 


I 


CLASSIFYING  CLINIC  CASES  153 

his  judgment  by  the  presence  or  absence  there  of  any 
marked  psycho-neurosis;  or,  though  the  mental  tests  may 
not  be  given,  further  judgment  as  to  the  child's  mentahty 
may  be  suspended  until  he  is  put  in  the  best  possible 
physical  condition.  This  may  require  a  simple  surgical 
operation  as  in  adenoid  growths,  or  a  long  course  of  medi- 
cal treatment  as  in  congenital  syphilis,  or  a  course  of 
constitutional  treatment,  possibly  in  the  country  or  at 
the  seashore,  as  in  instances  of  neglect,  malnutrition,  or 
incipient  tuberculosis. 

The  temporary  defects  having  been  removed,  their 
effect  upon  the  child  can  be  ascertained.  Before  they  are 
removed,  they  must  be  noted  and  their  effect  allowed  for. 
While  they  are  present  it  is  impossible  to  determine  with 
absolute  certainty  whether  the  deviation  is  due  to  them 
or  to  some  other  factors.  The  diagnostician  must  there- 
fore proceed  by  a  process  of  exclusion. 

Relation  of  Curable  Defects  to  Retardation. — On 
the  other  hand,  the  case  may  present  a  number  of  curable 
physical  defects  without  any  other  signs  of  amentia.  When 
these  are  present,  without  any  other  manifestations  of 
amentia,  they  may  be  taken  as  almost  decisive  in  marking 
temporary  and  curable  retardation.  In  order  that  the 
student  may  have  a  fair  notion  of  the  kinds  of  such  defects 
and  their  relation  the  results  of  some  investigations  are 
here  given. 

Diseases  of  the  eyes  and  ears  have  been  popularly  con- 
sidered as  immediate  and  certain  obstacles  to  the  acquisi- 
tion of  knowledge  b}^  ordinary  school  methods.  In  a  less 
degree  than  eye  and  ear  defects,  and  usually  more  re- 
motely, pharyngeal  and  nasal  afTections,  dental  caries  and 
tartar,  anemia,  malnutrition,  indigestion  and  other  intes- 
tinal troubles  have  all  been  alleged  as  causes  of  delay  in 


154     THE  CONSERVATION  OF  THE  CHILD 

mental  progress.  Limited  statistical  inquiry  into  the  rela- 
tions of  the  physical  condition  of  children  to  mentality 
do  not  wholly  substantiate  these  general  views.  A  partial 
summary  of  results  taken  from  various  sources  in  America 
Ayres'  is  givcn  by  Mr.  Ayres,  in  his  "Laggards  in  Our 
Records  Schools,"  Chapter  XI.  We  will  give  a  synopsis 
of  results  obtained  in  three  cities,  Philadelphia,  Camden 
and  New  York.  A  limited  investigation  was  made  into 
the  conditions  of  special  classes  in  Philadelphia  by  Dr. 
Cornell,  who  writes:  "The  results  showed  that  in  each 
school,  and  in  each  individual  branch  of  study  in  each  school, 
the  healthy  or  normal  children  stood  higher  in  their  classes 
than  the  average  children,  and  the  physical  defectives, 
taken  as  a  class,  stood  lower  than  the  average  children."  ^ 
However,  as  the  difference  between  the  general  average 
obtained  by  the  normal  children  and  the  general  average 
of  the  defective  children  was  only  three  per  cent.,  the  in- 
vestigation proved  that  while  physical  defectiveness  is 
assuredly  a  cause,  it  cannot  be  said  to  be  the  main  cause 
for  retardation  in  school  progress. 

Dr.  Newmaycr,  of  the  same  city,  classified  the  exempt 
and  non-exempt  among  5005  children  in  the  regular 
schools.  In  these  lists  the  defectives  were  almost  evenly 
divided  between  the  exempt  and  the  non-exempt,  with 
two  exceptions.  These  exceptions  comprised  the  mentally 
defective  and  those  suffering  from  skin  diseases,  both  of 
which  contributed  largely  to  the  non-exempt.  "That 
the  former  should  be  more  common  among  them  is  of 
course  to  be  expected.  That  they  should  be  found  to  be 
affected  more  commonly  with  skin  disease  is  probably 
rather  to  be  considered  a  reflection  of  poorer  home  con- 

2  Walter  S.  Cornell,  Thysical  Defects  of  School  Children,  The 
Psychological  Clinic,  vol.  i,  No.  8,  Jan.  15,  1908,  p.  232. 


A  cast  of  a  child's  jaw  inalformod  so  that   the  front  teeth  do  not 
come  tosiether. 


The    \'-shai)ed    u-pper   jaw    which    >)    niitii    accompanies    adenoid 

•irow  ths. 


CLASSIFYING  CLINIC  CASES  155 

ditions  than  having  a  direct  connection  with  their  mental 
aptitudes."^ 

"During  1906,  Superintendent  of  Public  Schools,  James 
E.  Bryan,  conducted  extensive  investigations  in  the  schools 
of  Camden,  New  Jersey.  In  all  10,130  children  were 
given  physical  examination.  Of  these  children  8100  were 
of  normal  age  and  2020  retarded."  ■* 

The  results  of  the  vision  and  hearing  tests  showed  such 
slight  differences  in  the  two  classes  that  they  made  one 
hesitate  to  draw  any  conclusions  as  to  any  rela-  Bryan's 
tion  between  retardation  and  defective  vision  or  Records 
hearing.  "Among  the  children  studied  1852  had  failed  of 
promotion  and  these  children  were  given  still  further 
examinations.  Among  them  1279  were  of  normal  age  and 
573  were  retarded."  ^  A  tabulation  of  the  results  gave  the 
surprising  information  that  the  children  of  normal  age 
showed  a  higher  percentage  of  defective  vision  and  hear- 
ing than  did  the  retarded  ones. 

To  study  the  causes  of  retardation  still  further  investi- 
gation was  made  to  determine  why  2020  children  were  over 
age  for  their  grades.  The  physical  defects  most  common, 
other  than  defective  sight  and  hearing,  accounted  for  3.9 
per  cent,  of  the  number,  and  ill-health  for  9.6  per  cent.  more. 
The  other  causes  were  either  environmental  or  mental. 

The  New  York  City  investigation  covered  20,000  chil- 
dren, of  whom  7608  had  been  physically  examined  before. 
Of  the  latter,  6084  fell  within  the  normal  age  n^w  York 
and  1524  were  above  normal  age.  The  sur-  Records 
prising  result  was  found  in  the  fact  that  80  per  cent,  of 
the  normal  and  only  75  per  cent,  of  the  backward  children 

^  Ijoggards  in  Our  Schools,  Leonard  P.  Ayres,  1909,  p.  119. 

*  Ibid. 
Mbid. 


156     THE  CONSERVATION  OF  THE  CHILD 

suffered  from  physical  defects.  Further  study,  however,  re- 
vealed that  the  decrease  of  defects,  except  those  of  vision, 
kept  pace  with  advancing  age  from  six  to  fifteen  years. 

"This  is  true  whether  they  are  behind  their  grades  or 
well  kept  up  in  their  studies.  Therefore,  it  is  not  surprising 
that  we  find  that  80  per  cent,  of  all  children  of  normal  age 
have  physical  defects  more  or  less  serious,  while  only  75 
per  cent,  of  the  retarded  children  are  found  to  be  defective. 
This  does  not  mean  that  pupils  with  more  physical  defects 
are  brighter  mentally.  It  simply  means  that  retarded 
children  are  older,  and  that  older  pupils,  as  has  been 
shown,  have  fewer  defects."  ® 

Conclusions.— "What  then  shall  we  conclude  in  regard 
to  the  relation  between  physical  defects  and  school  progress 
in  the  light  of  the  different  investigations  which  have  been 
discussed?  We  have  seen  that  in  the  two  Philadelphia 
examinations  the  percentages  of  defectiveness  among 
'exempt'  and  'non-exempt'  children  are  very  similar. 
The  Camden  investigation  showed  very  little  difference 
as  regards  vision  and  hearing  between  retarded  children 
and  those  of  normal  age. 

"The  New  York  examination  shows  that  the  retarded 
children  have  on  the  whole  fewer  defects  than  those  of 
normal  age,  but  it  goes  further  than  this.  It  establishes 
the  important  principle  that  except  in  the  cases  of  vision 
older  children  have  fewer  defects,  and  it  shows  that  when 
children  who  are  badly  retarded  are  compared  with  nor- 
mal children  and  very  bright  children  in  the  same  age 
groups,  so  that  the  diminishing  of  defects  through  ad- 
vancing age  does  not  enter  as  a  factor,  the  children  rated  as 
'dull'  are  found  to  have  higher  percentages  of  each  sort 

*  Laggards  in  Our  Schools,  Leonard  P.  Ayres,  1909,  p.  123. 


I 


CLASSIFYING  CLINIC  CASES  157 

of  defect  than  the  normal  and  bright  children.  Here 
again  defective  vision  must  be  expected. 

"Moreover,  the  New  York  investigation  gives  us  quan- 
titative measures  of  the  retarding  forces  of  the  different 
kinds  of  defects.  In  general,  children  suffering  from 
physical  defects  are  found  to  make  8.8  per  cent,  less 
progress  than  do  children  having  no  physical  defects. 
Children  suffering  from  enlarged  glands  and  adenoids  are 
retarded  most,  Hypertrophied  tonsils,  defective  breath- 
ing and  defective  teeth  are  in  general  somewhat  less 
serious  in  their  effects.  No  statistical  correlation  is 
shown  between  slow  progress  and  defective  vision. 

"All  of  these  considerations  are  of  the  first  importance 
in  the  problem  of  retardation.  That  there  is  a  distinct 
correlation  between  physical  defectiveness  and  school 
progress  has  been  shown.  The  quantitative  measure  of 
the  retarding  force  shows  that  it  is  only  one  of  the  factors 
contriljuting  to  bring  about  the  serious  degree  of  retarda- 
tion which  exists  in  our  public  schools. 

"In  studying  the  problems  of  school  progress  and 
physical  defects  we  must  not  forget  that  school  success 
is  to  only  a  limited  extent  a  true  measure  of  real  ability. 
It  may  often  be  but  an  indication  of  adaptability  and 
docility.  Indeed,  it  would  not  be  surprising  to  find  that 
the  child  of  perfect  physical  soundness  and  exuberant 
health  had  so  many  outside  interests  as  to  render 
him  not  particularly  successful  in  school  work,  and 
that  he  found  the  rigid  discipline  of  the  school-room  so 
irksome  as  to  cause  him  to  fail  of  approbation  by  his 
teachers. 

"Where  the  personal  equation  is  so  important  and 
methods  and  standards  so  little  established  as  in  the  field 
of  medical  inspection,  the  greatest  caution  must  be  exer- 


158     THE  CONSERVATION  OF  THE  CHILD 

cised  in  drawing  sweeping  conclusions  from  the  figures 
furnished.    We  have  shown: 

"  1.  That  physical  defects  decrease  with  age;  that  age 
is  the  important  factor  and  must  be  taken  into 

Summary  .  .  .  .  i       !•  .1 

consideration  m  all  investigations  dealing  with 
defectiveness  and  school  progress. 

"  2.  It  has  been  shown  that  vision  does  not  follow  the 
same  rules  as  do  the  other  defects. 

"  3.  The  examinations  conducted  in  New  York  have 
shown  higher  percentages  of  enlarged  glands,  defective 
breathing,  hypertrophied  tonsils  and  adenoids  among  the 
dull  children  than  among  the  bright  children. 

"  4.  It  has  been  demonstrated  that  physical  defective- 
ness has  a  distinct  and  important  bearing  on  the  progress 
of  children."  ^ 

The  Evidence  of  the  Clinic — Supplementary  to  the 
somewhat  restricted  evidence  of  these  necessarily  more 
or  less  hasty  examinations  of  masses  of  children  comes 
the  cumulative  evidence  furnished  by  the  painstaking  and 
complete  diagnosis  of  psychological  clinics.  Thus  far, 
the  testimony  so  gathered  points  to  a  much  more  signifi- 
cant connection  between  retardation  and  physical  defects. 
A  number  of  cases  will  be  cited  in  later  chapters  in  which 
medical  or  surgical  relief  was  followed  by  marked  and 
almost  immediately  increased  ability  to  make  progress  in 
school.  To  this  was  added  the  testimony  of  parents  to  a 
generally  increased  mental  capacity.  In  one  gi'oup 
thirteen  troublesome  adolescent  boys,  composing  a  special 
class  conducted  by  the  Psychological  Clinic,  every  one  of 
the  pupils  required  and  received  medical  attention  within 
the  half  year  previous  to  the  close  of  the  special  term  of 

'  Laggards  in  Our  Schools,  Leonard  P.  Ayres,  1909,  pp.  128-131. 


CLASSIFYING  CLINIC  CASES  159 

six  weeks,  and  all  of  them  were  reported  as  showing  im- 
provement in  mental  ability  and  conduct.**  By  such  ^^' 
experimentation,  l)y  daily,  careful,  complete  examinations 
and  tabulation  of  results  observed  either  in  a  hospital  school 
or  by  the  social  workers,  the  Psychological  Clinic  is  con- 
tributing its  quota  to  the  solution  of  this  vexing  and  urgent 
pedagogical  problem  of  relationship  between  the  physical 
and  the  psychical  in  backward  children. 

As  has  been  suggested  above,  the  peculiar  value  of  the 
contribution  made  by  the  clinic  lies  in  its  method  as  com- 
pared with  that  of  ordinary  medical  inspection.  Great 
good  is  being  done  by  the  latter  method.  Results  already 
obtained  have  more  than  justified  the  further  extension 
of  the  system  as  a  necessary  and  integral  part  of  the  school 
organization.  But,  by  the  very  nature  of  the  case,  because  "^ 
of  the  necessity  of  dealing  with  large  numbers  of  children, 
of  making  examinations  in  school-rooms  or  other  places 
unfitted  for  observation  of  defects,  because  of  the  imprac- 
ticability of  making  any  thorough  inspection  of  important 
organs  closely  concerned  in  mental  and  moral  aberrations, 
as  well  as  the  fruitlessness  of  hoping  that  medical  inspec- 
tors will  ever  become  specialists  in  children's  diseases, 
medical  inspection  in  public  schools  cannot,  for  a  long 
time  at  least,  do  more  than  discover  the  striking  instances 
of  physical  defects.  Under  the  present  circumstances, 
even  this  is  not  always  accomplished,  as  is  shown 

,  .  ,.       ,   .  .  1         1        •         1    Clinical  and 

by  comparmg  medical  mspection  cards  obtained        Medical 

1  1  •!  1  1         1        •    1  ••      1  Inspection 

by  some  children  at  school  with  reports  ot  the 
same  children  after  an  examination  at  the  clinic.     Total 
deafness  in  one  ear  has  been  overlooked  by  a  good  inspec- 
tor.    Impacted  and  retarded  dentition  is  most  difficult 

*  A  Pedagogical  Experiment  with  Troublesome  Adolescent  Boys, 
The  Psychological  Clinic,  vol.  iv,  No.  G,  Nov.  15,  1910. 


160     THE  CONSERVATION  OF  THE  CHILD 

of  discovery  by  casual  inspection  and  is  frequently 
unnoticed.  As  an  example  of  discrepancies, — fortunately 
not  very  frequent, — between  medical  inspection  in  school 
and  in  a  psychological  clinic  the  following  parallel  is  an 
extreme  though  an  actual  case : 


Medical  Inspection  Card,  Year  Ending  June,  1909. 


Eye. 


Ear 
Normal. 


Throat 
Normal. 


Nose 
Normal. 


Skin  Orthopedic 

Normal.     Normal. 


-P 


Clinic  Report,  November  15,  1910. 


Subnormal. 


Hearing     di- 

Mouth 

Nasal    or 

Normal. 

minished, 

breathing 

ph  ary'n- 

especially 

indicates 

ge  al  ob- 

right ear. 

adenoids; 
tonsils  en- 
larged. 

struction. 

Requires  medical 
examination  and 
urine  analysis. 
Heart  irregular 
and  somewhat 
rapid.  Teeth  very 
irregular,  decayed, 
some  missing. 


Recommended. — That  nose,  throat,  ears,  eyes,  and  teeth  be  examined  by 
specialists ;  that  a  general  medical  examination  be  made,  including  a  test  of  urine. 

The  lapse  of  time  between  the  two  examinations  is 
certainly  an  extenuating  circumstance,  but  is  hardly  suffi- 
cient to  account  for  all  the  discrepancies.  Some  of  them 
are  undeniably  due  to  differences  in  method  and  thorough- 
ness of  diagnosis.  This  case,  as  well  as  others  more  or 
less  similar,  tends  to  show  the  strong  advisability  of  having 
some  institution  ready  to  supplement  the  work  of  the 
school  examiner  both  in  making  more  detailed  examina- 
tions and  in  following  up  the  cases.  This  service  the 
clinic  is  well  equipped  to  perform.  When  awakening 
interest  and  growing  intelligence  have  taken  adequate 
cognizance  of  the  need,  no  first-class  city  school  system 
will   be   considered   complete   without   its  psychological 


CLASSIFYING  CLINIC  CASES  161 

clinic,  just  as  now  it  is  not  complete  without  its  medical 
inspectors. 

The  Discovery  of  Incurable  Physical  Defects. — When 
the  physical  examination  has  taken  full  account  of  the 
removable  physical  defects  just  described,  the  study  of 
the  stigmata  of  degeneration  still  remains.  Something 
has  already  been  said  in  a  previous  chapter  regarding  the 
relative  non-importance  of  these  signs  unless  they  are 
found  in  conjunction  with  other  evidences  of  mental 
defect  or  in  such  numbers  and  degree  of  abnormality  that 
their  significance  is  beyond  dispute.  As  far  as  we  have 
gone  with  our  supposed  case  of  the  boy,  the  evidence  from 
the  stigmata  can  be  corroborated  only  by  his  personal 
pedagogical  and  family  history.  These  facts  must  be 
elicited  from  the  parents  by  personal  questioning,  but  the 
physical  traits  are  subject  to  inspection.  What  both  of 
these  facts  are  and  how  they  confirm  each  other  ma}-  be 
best  understood  from  a  description  of  the  typical  sub- 
normal child,  first,  in  general  character  and  appearance, 
and  then  in  greater  detail  by  noting  the  peculiarities  of 
each  organ  of  the  body.  It  is  important  to  make  the 
classification  as  early  as  possible  in  the  child's  life,  and 
since,  if  it  is  not  made  at  an  early  age,  the  personal  history 
must  be  carefully  considered,  we  will  begin  with  infancy.^ 

First,  vnth  regard  to  temperament  or  disposition,  mentally 
deficient  children  may  be  divided  into  the  excitable  and  the 
apathetic.  Care  must  be  taken  here  not  to  confuse  the 
activity  of  the  excitable  class  with  superior  mentalitj'. 
The  apathetic  child  may  be  as  educable  and  as  able  to 


'For  fuller  description  of  the  physical  characteristics  of  im- 
beciles see  Mental  Defectives,  Martin  \V.  Barr,  1904.  Chap.  V;  and 
Feeble-mindednesa  in  Cliildren  of  School  Age,  C.  Paget  Lapage. 
1911,  Chap.  II. 

11 


162      THE  CONSERVATION  OF  THE  CHILD 

learn  as  the  excitable,  but  nearly  always  the  inexpert 
observer  will  give  the  latter  more  credit  than  the  former, 
on  the  principle  that  a  person  who  does  something  is 
brighter  than  one  who  does  nothing. 

The  feeble-minded  baby  may  be  extremely  quiet,  there- 
fore, with  prolonged  periods  of  slumber,  lying  passively  in 
any  position  in  which  it  is  laid  down,  with  almost  no  at- 
tempt to  move  its  hands  or  feet,  or  its  eyes.  Such  a 
baby  is  in  special  danger  of  neglect  regarding  its 
mental  condition,  for  it  is  pretty  certain  to  be  called  a 
"good  baby"  and  the  mother  is  able  to  ''get  so  much 
done"  on  account  of  its  abnormal  quietness.  Later  on, 
when  walking  time  comes,  the  unfounded  complacence 
of  the  parents  will  turn  to  dismay  as  they  see  months, 
and  sometimes  even  years,  come  and  go  without  their 
child  making  any  attempt  to  take  his  first  step. 
Even  under  such  circumstances,  the  strange  fatuity 
of  fond  parents,  sometimes  abetted  by  the  family 
physician,  will  predict  that  their  child  will  "outgrow" 
his  present  dulness  and  "brighten  up"  later  on,  possibly 
when  he  is  seven  years  old;  or  if  not  then,  when  he  is 
fourteen;  or  if  that  birthday  comes  without  bringing  im- 
provement, when  he  is  twenty-one !  If  such  hoping  against 
hope  were  not  born  of  the  best  in  human  nature  it  would 
deserve  unmeasured  condemnation.  As  things  are,  it  must 
be  condoned  as  ignorance  for  which  possibly  others  are 
more  to  blame  than  the  parents. 

The  very  opposite  to  the  apathetic  haby  is  the  excitable. 
Here  all  is  agitation, — constant  activity  in  uncoordinated, 
pm-poseless,  jerky  motions.  This  is  the  typical  "cross 
baby,"  fretful,  peevish,  nervous  to  an  unexplainable  de- 
gree, always  irritable  and  crying  without  cause  and  refusing 
to  be  pacified.    Hardly  has  it  been  put  to  sleep  with  great 


CLASSIFYING  CLINIC  CASES  163 

effort  and  much  rocking  before  it  is  again  awake  and  fret- 
ting. Even  in  sleep  it  does  not  rest  quietly,  but  jerks 
about  with  fitful  choreic  movements.  Such  a  child  is 
more  fortunate  in  one  respect  than  its  more  placid  brother. 
It  draws  attention  and  its  peculiarities  demand  investiga- 
tion. Relatives  and  friends  are  questioned;  the  family- 
physician  is  consulted  concerning  it;  sometimes  specialists 
iu-e  brought  in.  Unfortunately,  too  little  information  is 
usually  given  and  often  the  simple  report  is  made  that  the 
baby  is  "just  a  crying  baby"  and  the  soothing  formula  of 
"it-will-outgrow-it"  silences  the  parents'  fears,  until 
backwardness  in  doing  the  simple  things  of  life  awakens 
them  to  an  appreciation  that  something  is  radically  wrong. 

In  both  classes  of  children  slowness  is  the  first  sign  of 
mental  trouble.  It  probably  arises  from  the  generally 
fiaccid  and  incoordinated  muscular  system,  a  marked 
symptom  which  persists  during  the  whole  life  and  enters 
into  every  effort  from  the  first  crude  attempts  at  sucking, — 
ineffectual  because  of  inability  to  close  the  lips  over  the 
bottle  or  nipple, — through  incontinence  of  urine,  slavering, 
with  hanging  lower  lip  and  hyperaemic  salivary  glands, 
faltering  attempts  at  walking  and  continued  shuffling 
gait,  up  to  the  adult's  fumbling  attempts  to  perform  the 
acts  of  any  manual  occupation.  Muscular  tone,  muscular 
precision,  coordination,  "snap,"  vigor,  dexterity — 'all  the 
little  knacks  which  come  so  naturally  to  the  normal  child 
from  the  very  first  attempt  to  reach  for  the  light,  are 
wanting  in  the  defective. 

Whe7i  babyhood  is  passed  and  childhood  begins  with  the 
first  words,  first  steps,  and  first  teeth,  other  symptoms  begin 
to  make  their  appearance.  The  hearing  is  often  imperfect, 
as  is  manifested  in  inattention  to  commands  or  spoken 
discourse  and  the  sounds  which  would  attract  the  child  of 


164     THE  CONSERVATION  OF  THE  CHILD 

normal  audition.  On  this  account,  speech  is  delayed  and 
when  words  are  finally  acquired  they  are  so  inarticulate 
that  nobody  understands  what  is  said  except  those  familiar 
with  the  child.  This  is  the  case  long  after  the  normal  child 
is  talking  clearly.  Speech,  indeed,  is  one  of  the  best 
indications  of  the  degree  of  mentality.  The  natural  child 
begins  to  talk  between  nine  or  ten  months  and  sixteen 
months  of  age.  Sometimes  talking  may  be  slowly  acquired 
and  putting  words  together  with  any  meaning  may  be 
delayed  until  eighteen  months  or  two  years.  This,  how- 
ever, should  cause  apprehension,  and  if,  after  an  examina- 
tion by  a  specialist,  no  abnormality  is  found  in  the  vocal 
organs,  grave  consideration  should  be  given  to  the  case. 
If  speech  is  not  begun  by  the  seventh  year,  with  no  organic 
defect  to  account  for  it,  such  as  some  acute  illness,  mal- 
nutrition, or  malformation  of  vocal  organs,  mental  defi- 
ciency is  almost  certain  to  be  the  cause.  In  that  case, 
training  in  talking  is  of  no  avail;  the  child  does  not  talk 
because  it  has  nothing  to  express. 

Next  to  sneaking  in  symptomatic  importance  comes  walk- 
ing. Even  after  the  natural  inertia  of  the  defective  has 
been  overcome  by  a  budding  interest  in  things  about  him 
and  a  desire  to  imitate  other  children  in  moving  about, 
the  muscular  incoordination  which  underlies  all  his  activi- 
ties gives  him  a  slouchy,  staggering  gait  with  body  bent 
forward  and  hands  falteringly  extended  like  a  decrepit 
old  man.  There  is  a  curious  atavistic  return  to  the  ape- 
attitude  in  both  standing  and  walking.  The  body  is  bent 
forward  at  the  hips,  the  knees  are  also  bent,  the  hands 
swing  low  and  the  shoulders  droop  forward.  In  move- 
ment the  feet  are  dragged,  the  step  is  slow,  running  is  an 
art  of  late  acquirement  and  performed  only  with  constant 
fear  of  falling;  steps  are  climbed  one  at  a  time,  games  are 


CLASSIFYING  CLINIC  CASES  10.5 

only  half  entered  into,  and  thore  is  usually  a  general 
appearance  of  weariness  unnatural  to  boisterous  child- 
hood. When  the  defective  is  excited,  and  more  commonly 
in  the  case  of  the  excitable  type,  a  nervous  flightiness  with 
a  disposition  to  wander  aimlessly  from  one  thing  to  another 
exhibits  itself. 

Play. — In  play,  the  best  and  truest  expression  of  all 
there  is  in  childhood,  the  weak-minded  unfortunate  shows 
his  preference  for  mates  much  younger  than  himsel  f .  With 
them  he  feels  somewhat  at  home.  With  those  of  his  own 
age  he  is  hopelessly  handicapped  and  becomes  either  the 
petty  servant  of  his  comrades  or  else  the  butt  and  sport 
of  the  unfeeling  ones.  Oftentimes  his  play  with  others  is 
made  up  largely  of  meaningless  chatter  and  silly  laughter, 
with  peculiar,  excitable  movements,  like  jumping  up  and 
down,  screaming  at  intervals,  waving  his  arms  and  making 
grimaces.  If  he  cannot  take  refuge  with  younger  children 
he  may  fall  into  a  sullen  indifference  to  his  surroundings 
and  express  an  aversion  to  companionship  of  any  kind. 

Fatigue. — In  attempting  to  learn  anything  new,  whether 
it  be  a  game  or  a  lesson  or  the  simple  acts  of  dressing, 
washing  or  combing  his  hair,  he  very  quickly  gives  evidence 
of  fatigue.  He  is  prone  to  give  up  and  to  turn  his  flighty 
attention  to  something  else.  If  he  is  restrained  from 
wandering  and  compelled  to  fix  his  mind  upon  the  task 
in  hand,  further  fatigue  symptoms  appear  in  nervously 
moving  hands,  in  jerky,  foolish  little  motions,  redness  of 
cheeks,  brightness  of  eyes,  followed,  if  further  pressure  is 
brought  to  bear,  by  a  tremulous  excitement  which  com- 
municates itself  to  nearly  the  whole  body  and  ends  with 
tears  and  sobbing  and  complete  inability  to  do  anything 
whatever.  To  push  a  child  to  such  an  extreme  is  an  act  of 
folly  in  parent  or  teacher  impossible  to  criticise  too  severely. 


lOG     THE  CONSERVATION  OF  THE  CHH^D 

Yet  it  is  often  done  under  tlu;  ])lindly  ignorant  notion 
that  the  child  can  if  he  will,  or  that  he  is  lazy,  because  the 
uninformed  adult  measures  the  child's  powers  by  that  of  a 
normal  child  and  does  not  understand  that  this  very 
inability  to  stick  to  a  task  is  a  sure  token  of  mental 
deficiency. 

Inattention. — If  idiots  of  any  grade  could  only  pay 
attention,  and  pay  attention  long  enough,  they  could 
learn  anything  as  well,  if  not  as  fast,  as  one  with  a  brilliant 
mind.  Attention,  however,  is  the  adjustment  of  some 
organ  of  sense — usually  the  eyes — to  some  stimulus  or 
upon  some  point  of  interest,  and  depends  upon  the  ability 
to  coordinate  and  keep  certain  muscles  at  a  certain 
tension.  This,  as  has  already  been  said,  is  a  fundamental 
defect  of  the  weak-minded.  Therefore,  fatigue,  as  mani- 
fested in  flightiness  of  attention,  is  a  marked  and  usual 
characteristic  of  the  class.  In  early  childhood  it  shows 
itself  in  complete  indifference  to  the  toys  which  are  ordi- 
narily objects  of  intense  desire  to  a  normal  child.  The 
healthy  baby  will  strain  and  grasp  and  kick  to  get  at  some 
bright  colored  object  held  before  its  eyes.  The  little 
child  will  run  after  any  new  object  rolled  or  thrown  before 
it.  Curiosity  prompts  attention  and  attention  prompts 
ready  and  vigorous  movement  toward  the  interesting  toy. 
Not  so  with  the  defective.  Stolid  indifference  is  the 
reward  of  any  one  who  tries  to  interest  him  with  the 
lirightest,  newest,  shiniest  toy.  If  the  ball  is  rolled  before 
him,  he  stares  with  blank  or  inquiring  face,  but  does  not 
make  any  effort  to  follow  it.  Only  by  the  most  persistent 
and  painstaking  devices  is  attention  aroused,  to  be  held 
for  only  a  moment,  before  some  other  equally  stimulating 
thing  attracts,  fatigue  sets  in,  or  stolid  indifference  again 
closes  down  like  a  pall  upon  the  momentarily  lighted  face. 


CLASSIFYING  CLINIC  CASES  167 

Imitation. — Under  such  circumstances  it  is  not  sur- 
prising to  find  that  imitation  is  at  first  almost  wholly 
absent,  and,  later  on  in  childhood,  at  the  school-age,  it  is 
but  lame  and  feeble  in  comparison  with  the  ready  mimicry 
of  the  vigorous  boy  or  girl.  In  a  family  with  many  other 
children,  the  commonest  acts  of  everyday  life  must  be 
laboriously  taught  the  defective  instead  of  being  spontane- 
ously imitated.  Learning  to  dress  costs  as  much  time  and 
labor  as  a  normal  child  spends  in  learning  to  write.  And 
so  with  other  daily  duties.  Washing  the  face  and  hands, 
combing  the  hair,  putting  on  shoes,  tying  strings  or  ribbons, 
or  any  one  of  the  thousand  and  one  simple  acts  learned 
unconsciouslj''  bj^  the  rest  of  the  family  are  sources  of 
endless  worry  and  much  practice  to  these  helpless  ones. 

These  are  the  general  charactenstics  of  the  defectives.  They 
are  open  to  inspection  by  any  eye  and  can  be  watched 
daily  in  the  home  or  in  the  school.  No  special  skill  is 
required  in  their  observation.  Their  significance  must  be 
understood  and  it  must  not  be  asserted  that  their  causes 
reside  '.n  the  mere  unwillingness  of  the  afflicted  one.  They 
must  be  treated  as  symptoms  having  a  sinister  meaning 
for  the  future  mental  accomplishments  of  their  possessor, 
to  be  overcome  by  the  most  patient,  skilful  and  persistent 
training  by  teachers  fitted  by  nature  and  experience  for 
the  delicate  task. 

Particular  Stigmata  Alone  are  not  Conclusive  Evi- 
dence of  Amentia. — Passing  now  from  these  general 
characteristics  to  a  little  closer  scrutiny  of  the  various 
organs  of  the  defective  child,  we  will  see  how  they  may 
differ  in  a  typical  case  from  those  of  a  normal  human 
being.  In  the  study  of  congenital  physical  abnormalities 
or  stigmata,  it  must  ])e  remembered  that  probably  no  one 
caae  will  present  all  the  signs  of  degeneration.     Neither, 


168     THE  CONSERVATION  OF  THE  CHILD 

on  the  other  hand,  should  any  person  be  adjudged  sub- 
normal because  of  the  presence  of  one  or  many  of  the 
degenerative  marks.  In  fact,  it  would  be  almost  a  perfect 
specimen  of  the  human  race  who  could  submit  to  a  minute 
inspection  and  escape  without  a  mark  against  him.  At 
present  there  is  a  distinct  reaction  against  the  theories 
of  Lombroso  and  his  school,  who  taught,  but  a  short  time 
ago,  that  the  mentality  and  moral  character  of  men  could 
be  read  from  their  bodily  idiosyncrasies  as  from  the  pages 
of  a  book.  Later  investigations  by  Dr.  Travis'"  and  others 
tend  to  modify  the  extreme  views  of  the  stigmatic  school 
and  to  place  less  emphasis  upon  the  shape  and  size  of 
craniums,  position  and  development  of  ears,  eyes,  nose, 
hands  and  other  organs.  A  man  with  silky  curly  hair 
and  delicate  tapering  fingers  may  have  a  few  qualifica- 
tions for  the  career  of  a  successful  pickpocket,  but  it 
would  assuredly  be  preposterous  to  arrest  every  such  man 
because  of  these  misfortunes  of  birth. 

In  fact,  it  is  safe  to  say  that  physical  signs  of  degenera- 
tion, taken  by  themselves,  are  most  untrustworthy  evi- 
Btigmata  dcuce  upou  which  to  base  predictions  of  intel- 
beTr'aken"'^  Icctual  or  moral  accomplishments.  Taken  in 
^^°^^  consideration,    for    example,    with    conduct   or 

character  as  revealed  in  a  long  series  of  actions  all  tending 
toward  increasing  retardation  in  any  child  who  is  falling 
farther  and  farther  behind  his  companions  in  school- 
grades,  stigmata  have  a  considerable  weight  in  deciding  the 
causes  of  such  tendencies  of  conduct.  A  microcephalic 
skull,  i.e.,  one  smaller  in  birth  than  the  average,  in  itself 
sign  fies  nothing  regarding  mental  endowment.  Men  with 
such  reduced  brain  spaces  arc  found  in  professors'  chairs 

1"  The  Young  Malefactor,  Thomas  Travis.  New  York,  T.  Y. 
Crowell  &  Co.,  1908. 


C^2. 


CLASSIFYING  CLINIC  CASES  169 

as  well  as  in  asylums  for  dements.  Only  when  the  small 
head  is  found  upon  the  shoulders  of  a  person  with  a  record 
for  extreme  slowness,  distinct  inability  to  perform  certain 
common  mental  tasks,  like  arithmetic,  or  with  a  record 
of  persistent  and  uncalled-for  criminal  acts,  does  it  mean 
such. 

The  Shape  of  the  Skull.— With  these  words  of  warn- 
ing, we  will  mention  a  few  points  to  lie  especially  noted 
in  the  examination  of  a  backward  child  for  Micro- 
incurable  mental  deficiency.  The  shape  of  the  "''^  ^^ 
skull  is  a  prominent  characteristic  in  many  typical  cases 
of  imbecility.  It  may  be  too  small  in  girth  measured  just 
above  the  eyes  and  ears,  as  compared  with  the  height, 
weight,  and  age  of  the  child.  For  the  average  girth,  or 
standard,  the  "Manual  of  Physical  Measurements,"  by 
William  W.  Hastings,  published  in  1902  by  the  Y.  M.  C.  A. 
Training  School  at  Springfield,  Mass.,  or  similar  tables 
may  be  consulted,  though  it  must  be  remembered  that  a 
slight  deviation  in  this  one  dimension  is  not  critical  and 
that  real  microcephalic  iml)ecility  is  usually  character- 
ized by  a  head  not  only  small  but  also  sloping  suddenly 
in  a  nearly  perpendicular  line  to  the  neck,  thus  giving  a 
somewhat  flattened  occiput.  From  above,  such  a  head 
presents  a  beautiful  oval,  Avith  its  widest  portion  about 
over  the  ears  and  narrowing  toward  the  forehead. 

Opposite  to  the  microcephalic  is  the  hydrocephalic  skull, 
or  the  one  with  "water  on  the  brain."  Here  again  it  is 
to  be  remembered  that  not  all  hydrocephalics  Hydro- 
are  feeble-minded.  When  the  condition  is  found  '■^p'^^y 
with  feeble-minded  conduct  it  argues  decisively  that  the 
fluid  Avhich  has  collected  in  the  brain-cavities  called  ven- 
tricles, or  between  the  brain  coverings  called  meninges, 
has  also  brought  about  degenerative  chimges  in  the  organ 


170     THE  CONSERVATION  OF  THE  CHILD 

itself.  This  may  be  due  to  pressure  from  within  which 
has  caused  the  skull  to  bulge  over  the  ears,  and  especially 
over  the  eyes,  until,  in  extreme  cases,  the  patient  becomes 
so  top-heavy  he  is  unable  to  walk.  In  milder  cases,  the 
bulging  shape  of  the  cranium  and  abnormal  girth,  measured 
with  the  tape-line,  will  usually  fix  the  source  of  the  trouble. 

It  might  be  noted,  as  a  matter  of  passing  interest,  that 
the  "pressure  on  the  brain,"  so  often  referred  to  by  those 
Pressure  on  unacQuaintcd  with  the  true  causes  of  idiocy,  is 
the  Brain  almost  always  alleged  for  the  explanation  of 
dulness  in  the  microcephalic  child,  but  almost  never  in 
the  case  of  the  hydrocephalic.  The  opposite,  if  anything, 
is  true.  If  there  is  any  abnormal  pressure  at  all  upon  the 
brain,  it  occurs  with  the  big-headed  and  not  with  the  little- 
headed  sufferers.  In  neither  case  is  there  any  severe  pres- 
sure, for  it  is  a  law  of  growth  that  hard  structures  will 
conform  themselves  to  softer  parts  of  the  same  organism. 

Beside  these  two  common  sizes  and  shapes  in  skull  for- 
mation, another  must  be  placed,  probably  met  with  more 
frequently  but  possibly  not  so  often  accompanied  with 
mental  aberration.  It  is  called  the  "box-shaped"  or  the 
rachitic  skull,  because  it  indicates  the  presence  of  rickets 
in  babyhood,  or  at  least  some  severe  fault  of  nutrition. 
The  skull  is  brachycephalic,  short  and  broad,  with  a  wide, 
flat  forehead,  two  rounded  corners,  one  above  each  eye, 
two  more  comers  at  the  occipito-parietal  points  and  a 
flattened  occipital  surface,  or  with  the  relatively  large 
dorsal  protuberance  which  seems  to  be  plastered  upon  an 
otherwise  flat  surface. 

The  "box-shaped"  skull  does  not  indicate  mental 
deficiency  because  of  the  malformed  brain  underneath, 
but  because  of  the  malnutrition,  marasmus  or  rickets 
suffered  at  one  time  by  the  possessor  of  such  a  head  and 


CLASSIFYING  CLINIC  CASES  171 

the  consequent  non-development  of  nerve  centres  along 
with  general  retardation  of  all  parts  of  the  body.  A  box- 
shaped  skull,  therefore,  usually  accompanies  a  Rachitic 
lack   of  all-round  physical  growth,    undersize,  ^''"" 

under-weight,  deformed  ribs  bent  at  the  sternum  into 
the  so-called  "rosary,"  Hutchinson's  groove,  enlarged 
epiphyses  and  lowered  general  physical  tone.  If  such 
sjTnptoms  have  been  largely  overcome  by  later  feeding 
and  care,  the  brain  has  usually  developed  correspondingly. 

The  Ear. — The  study  of  defective  ears  alone  would 
make  a  volume.  One  specialist  enumerated  thirty-eight 
distinctive  stigmata  of  the  auditory  organ  which  betrayed 
lowered  mentality  in  varying  degrees.  Such  minute  study 
of  degenerate  marks  from  a  scientific  point  of  view  alone 
is  always  open  to  question,  and  for  the  clinician  has  no 
practical  value.  The  grosser  and  more  striking  variations 
from  type  exhibited  in  the  size,  shape,  position  and  devel- 
opment of  the  ears  in  any  suspected  case  of  degeneracy 
have  some  significance  and  should  })e  given  their  due  pro- 
portion of  weight  in  the  final  decision  regarding  the  mental 
status  of  their  possessor. 

The  ear,  taken  as  a  whole,  may  be  deformed, — large, 
twisted,  or  rudimentary.  The  lobules  are  special  sources 
of  defect,  being  rudimentary,  absent  or  adherent.  The 
pinnce,  the  helices  and  the  anti-helices  are  often  faulty 
and  undeveloped.  Darwinian  tubercles — small  cartilagi- 
nous nodules — may  be  present,  sometimes  several  on  the 
helix  of  each  ear,  but  are  no  more  frequent  in  the  mentally 
defective  than  in  normal  people.  The  position  of  the  ear, 
looking  at  the  head  upon  the  lateral  aspect,  frequently 
appears  to  be  farther  back  than  it  should  be.  This  often 
arises  from  the  fact  that  the  skull  is  flattened  in  the 
occipital  region,  as  in  the  cases  of  microcephaly  and  rickets. 


172     THE  CONSERVATION  OF  THE  CHILD 

After  the  ears,  probably  comes  the  nose  in  diagnostic 
importance.  Its  shape  and  development  are  of  especial 
significance.  The  commonest  structural  abnormalities 
are  those  associated  with  adenoids.  Where  adenoids  are 
present  the  nose  widens  and  thickens  without  any  marked 
depression  of  the  bridge,  while  at  the  same  time  the  alae 
seem  to  cease  their  growth  and  remain  infantile,  without 
clean,  clear-cut  chiselling.  This  gives  a  "baby"  appear- 
ance to  the  whole  nose.  In  distinction  from  the  ordinary 
adenoid  nose,  the  nose  of  the  feeble-minded  is  usually 
flattened  at  the  bridge,  broad  at  the  nostrils,  with  wide 
alae,  the  whole  appearance  being  coarse  and  undeveloped. 

The  Mouth.— In  general,  the  mouth  belongs  to  one  of 
two  types:  the  lips  are  either  thick  and  coarse,  or  thin 
and  immobile.  The  palate  is  misshapen,  high-arched, 
keel-shaped,  and  V-shaped.  Frequently  the  gums  are 
much  swollen  and  spongy.  The  tongue  is  either  pointed, 
or  thick,  fissured  and  rough.  The  teeth  are  frequently 
decayed,  irregular,  and  oftentimes  the  normal  number  do 
not  appear.  In  the  case  of  amentia  due  to  syphilis,  the 
teeth  present  the  peculiar  peg-shape  and  notched  forms, 
sometimes  with  the  characteristic  Hutchinson's  notchings. 
In  the  lower  grades  of  mentally  deficient  children  sialorrhea 
or  drooling  is  very  common.  The  corners  of  the  mouth 
are  frequently  sore. 

The  Hands. — The  hands  are  powerless;  the  prehension 
is  almost  always  very  feeble;  the  fingers  are  thick,  clubbed, 
and  the  nails  brittle,  rough,  and  corrugated.  Coordina- 
tion is  extremely  undeveloped  and  manual  skill  very 
difficult  to  acquire. 

The  Skin. — Probably  one  of  the  first  signs  of  degeneracy 
noticeable  upon  the  presentation  of  a  feeble-minded  child 
at  the  cUnic  is  the  general  condition  of  the  skin.    Without 


The  hands  and  weblx'd  fingers  of  a  Mongoloid  idiot  boy. 


The  hands  of  an  imbeeile  l)oy,  tyi)ical  in  his  physical  apjiear- 
ance,  eighteen  years  old,  nnable  to  read  or  write,  but  can  talk  in 
simple  words  and  sentences. 


CLASSIFYING  CLINIC  CASES  173 

particular  attention  and  with  only  a  casual  glance,  even 
the  uninitiated  observer  recognizes  some  peculiarity  about 
it.  The  integument  is  usually  coarse  and  flabby;  there 
is  a  proneness  to  eczema,  rupia,  and  other  cutaneous 
diseases  in  general.  Oftentimes,  there  is  a  peculiar  pungent 
odor  coming  from  the  skin  not  due  wholly  to  lack  of  bath- 
ing. Vegetable  and  animal  parasites  find  a  congenial  soil 
in  the  skin  of  degenerates  and  will  sometimes  find  per- 
manent aliiding  places  upon  the  body  of  the  feeble-minded 
child  when  they  will  either  not  attack  or  will  be  speedily 
eliminated  from  his  normal  brothers  and  sisters  in  the 
family. 

The  Further  Sub-classification  of  Aments. — The 
above  description  of  the  various  organs  and  their  stigmata 
will  serve  to  distinguish  mental  deficiency  in  general. 
When  this  condition  is  classified,  however,  the  work  has 
just  begun.  The  next  process  is  to  decide  the  particular 
group  to  which  the  dement  belongs.  While  there  are  many 
degrees  of  amentia  and  the  extremes  of  the  highest  and 
the  lowest  mentality  stand  out  with  marked  vividness 
and  distinctness,  yet  the  degrees  merge  into  one  another 
in  stages  so  slightly  separated  from  those  above  or  below 
that  the  demarcations  are  exceedingly  hard  to  discern. 
In  other  words,  the  gradations  between  profound  idiocy 
and  high-grade  imbecile  are  not  steps  or  stages,  but,  if 
graphically  indicated,  should  be  shown  with  a  curve  with- 
out breaks.  In  nature,  mentally  defective  children  are 
not  graded.  Therefore  any  classification  that  is  made 
must  be  looked  upon  as  artificial,  and  to  some  extent 
arbitrary. 

The  Importance  of  Sub-classification. — Although 
this  is  true,  it  must  not  be  thought  that  classification  is 
merely  theoretical  or  academical,  and  without  practical 


174     THE  CONSERVATION  OF  THE  CHH^D 

value.  It  is  extremely  necessary  to  classify  a  child  in 
order  to  give  him  the  proper  kind  of  training.  For  the 
methods  of  training,  if  not  the  principles,  change  with 
degrees  of  degeneracy.  Thus  a  high-grade  imbecile  should 
be  educated  by  methods  different  and  far  more  rapid 
than  those  applicable  to  a  low-grade  imbecile. 

More  than  this,  the  ultimate  limit  to  which  the  training 
can  be  carried  and  the  intellectual  results  which  will 
accrue  to  the  subject  from  it  are  wholly  predicable  from 
the  degree  of  mental  deficiency  diagnosed.  It  is  of  supreme 
practical  importance  also,  where  the  problem  of  cost  and 
the  length  of  time  possible  to  devote  to  training  are  final 
for  deciding  what  shall  be  done  with  any  particular  child. 
Theoretically,  of  course,  and  under  ideal  conditions  where 
provision  is  made  for  every  defective,  such  practical  con- 
sideration as  the  last  would  not  be  important,  but  under 
the  present  conditions  they  often  become  decisive. 

The  Idiots. — With  these  few  words  of  introduction  we 
will  give  a  few  indications  of  the  different  stages  of  idiocy, 
idio-imbecihty  and  imbecility,  following  the  educational 
classification  already  laid  down  by  Dr.  Barr.  We  will 
begin  with  idiocy,  since  that  type  is  marked  in  its  symp- 
toms and  comparatively  simple  and  easy  of  diagnosis,  and 
then  proceed  to  the  higher  stages.  Idiocy  is  sub-classified 
as  profound  and  superficial.  With  the  profound  idiot, 
^vith  the  apathetic  disposition,  there  is  no  speech,  no  sound, 
no  movement,  and  as  Dr.  Barr  sums  it  up  he  is  "just  a 
breathing  mass  of  helplessness."  The  excited  idiot,  on 
the  other  hand,  may  utter  bleating  cries  with  constant 
movements  such  as  rolling  the  head  and  twisting  the  body 
and  making  rhythmic  motions  of  his  eyes  or  his  fingers. 
These  characteristics  are  sufficient  to  mark  this  stage; 
one,  happily,  with  which  the  public  very  seldom  comes  in 
contact. 


CLASSIF\7NG  CLINIC  CASES  175 

Just  above  the  profound  idiot  comes  the  superficial. 
In  the  case  of  the  apathetic  kind,  mutism  is  the  rule. 
Wants  are  made  known  by  signs,  or  by  inarticu-  superficial 
late  cries.    Often  the  limbs  are  wholly  or  partially  ''^'"'^ 

paralyzed  and  the  extremities  are  cold  and  livid.  When- 
ever the  idiot  is  able  to  walk  his  steps  are  those  of  tottering 
infancy.  Usually  he  sits  all  day  in  idleness  dribbling  saliva 
or  blowing  bubbles  from  his  mouth,  taking  very  little  if 
any  notice  of  things  going  on  about  him. 

His  excitable  brother  is  an  imp  of  mischief  with  a  violent 
temper,  wilful,  restless,  and  always  in  motion;  curious 
to  a  degree,  testing  everything  with  his  fingers  and  tongue 
and  swallowing  everything  that  he  can  got  into  his  mouth, 
including  stones,  rags,  sticks,  and  refuse  of  every  descrip- 
tion. His  speech  is  delayed  for  many  years  and  when 
finally  acquired  consists  of  nothing  more  than  broken 
sentences  of  monosyllabic  words,  accompanied  by  harsh, 
inhuman  cries  and  gestures.  His  gait  is  an  unsteady  shuffle 
with  a  dragging,  halting  step,  knees  "jack-knifed"  and 
body  bent  forward,  reminding  one  of  the  posture  of  an  ape. 

The  Idio-Imbeciles. — Above  the  idiot  and  below  the 
imbjeciles  come  the  idio-imbeciles.  They  share  the  physical 
characteristics  and  habits  of  the  idiot  \nth  something  of 
the  limitations  of  the  imbecile.  Again  the  dragging,  faulty 
step  and  lurching  gait  are  met,  though  much  improved  over 
the  idiot's.  Clumsiness  is  one  of  their  marked  character- 
istics and  exhibits  itself  because  of  increased  muscular 
power  which  is  yet  uncoordinated.  Their  speech  is  also 
limited  and  they  make  free  use  of  signs,  oftentimes  ac- 
companied with  a  senseless  chatter  and  silly  laughter. 
The  silly  humor  often  changes  into  sudden  and  unpro- 
voked anger.  The  skin  is  coarse  and  often  peels  off  in 
large  flakes.  Poor  circulation  is  accompanied  by  sores, 
ulcers,  chilblains,  and  frost-bites. 


176     THE  CONSERVATION  OF  THE  CHILD 

The  Imbeciles. — Passing  to  the  class  of  imbeciles 
beginning  with  those  of  low  grade,  we  find  the  stigmata 
are  still  marked.  Speech  is  usually  present  but  articula- 
tion is  defective;  the  vocabulary  is  limited  and  meaning- 
less chatter  very  common.  Reading  and  writing  are 
difficult  and  almost  impossible  to  acquire.  Often  the 
simplest  and  most  ordinary  occupations  of  making  a 
living  under  direction  require  all  the  ability  of  a  person 
of  this  grade,  and  beyond  this  he  will  probably  never  pro- 
ceed. His  life,  therefore,  should  be  spent  in  a  colony 
doing  under  the  most  careful  supervision  those  things  for 
which  he  is  best  fitted. 

One  remove  above  him  is  the  middle-grade  imbecile. 
Here  we  begin  to  note  for  the  first  time  an  approximation 
to  the  normal,  a  mentality  more  human  than 
Grade  '  animal.  In  comparison  with  the  other  grades 
™  ^^^ "  below,  the  middle-grade  imbecile  is  mild  and 
equable  in  temper.  He  readily  accepts  offered  suggestions, 
and  is  almost  wholly  influenced  by  his  environment  and 
companions.  Hence,  if  left  to  himself  he  readily  learns  all 
of  the  bad  habits  of  men  without  acquiring  their  more  diffi- 
cult virtues.  His  vision  and  hearing  are  often  defective. 
In  school  he  is  dull;  his  attention  is  feeble;  he  becomes  very 
easily  fatigued,  and,  when  pressed  beyond  his  endurance 
with  any  new  tasks,  becomes  excited,  confused  and  com- 
pletely helpless,  showing  his  state  of  mind  by  inability 
to  proceed  with  his  work,  staring  before  him  with  fixed 
eyes  and  flushed  cheeks,  or  else  breaking  out  in  anger  or 
giving  way  to  tears.  He  cannot  advance  beyond  the 
simplest  primary  lessons  in  books,  though  he  maybe  inter- 
ested in  Nature  and  in  manual  training.  He  is  able  to 
talk  comparatively  well,  though  defects  in  articulation  are 
common.     His  walk  and  movements  in  general  are  fairly 


CLASSIFYING  CLINIC  CASES  177 

well  coordinated  and  in  the  better  class  depart  very  little 
from  the  normal.  There  is,  however,  about  him  a  general 
air  of  vacuity  and  listlessness  which  marks  him  out  im- 
mediately from  the  alert,  precise,  normal  child. 

Hardly  to  be  distinguished  from  the  normal  child  is  the 
high-grade  imbecile,  and  here  the  classification  is  especially 
difficult  and  can  be  made  only  by  careful  and 
sometimes  prolonged  observation,  though  it  is  Grade 

easy  to  distinguish  him  from  the  normal  child  who 
makes  good  progress  in  school.  Between  him,  however,  and 
the  dull  or  backward  school  child  there  are,  on  the  surface, 
no  physical  differences.  It  is  only  the  closest  investigation 
of  his  heredity  and  life  history  that  certain  ancestral 
neurotic  tendencies  and  accumulations  of  little  departures 
from  the  normal  are  discovered,  and  that  will  finally  decide 
the  case.  It  is  especially  to  this  class  of  high-grade  im- 
beciles, and  to  some  extent  middle-grade  imbeciles,  that 
the  idiots  savants  belong.  These  aments  often  show  the 
most  remarkable  talent  in  one  particular  direction  or 
another.  This,  very  frequently,  takes  the  form  of  some 
manual  dexterity  like  drawing,  wood  carving,  or  carpenter 
work.  Sometimes  music  claims  their  genius  and  they 
accomplish  wonders  in  a  short  time.  Mathematics  also 
attract  some,  and  the  "lightning  calculator"  of  public 
exhibitions  frequently  belongs  to  this  class.  It  is  on 
account  of  such  facts  that  oftentimes  the  family  give  an 
account  of  a  precocious  babyhood,  or  of  bright  things  said 
and  done,  of  wonderful  memories  for  dates,  numbers,  and 
isolated  facts,  coupled  with  a  complete  inability  for  sys- 
tematic recollection  or  assimilation  of  ideas  gathered  from 
books.  Unless  such  high-grade  imbeciles  are  carefully 
trained  in  habits  of  labor  and  placed  in  an  environment 
where  they  will  not  come  into  competition  with  normal 
12 


178     THE  CONSERVATION  OF  THE  CHILD 

men,  they  are  likely  to  lose  one  job  after  another  and  finally 
to  drift  into  the  vagabond  or  ne'er-do-well  class. 

After  this  long  digression  we  return  again  to  our  boy 
under  examination.  At  this  stage  we  must  pause  and  ask 
if  he  fits  the  picture  of  any  mental  class  described  in  the 
preceding  paragraphs.  Are  his  physical  peculiarities  of 
the  kind  therein  described  as  belonging  to  imbeciles,  idio- 
imbeciles,  or  idiots?  Are  these  idiosyncrasies  confirmed 
by  his  personal  or  family  history?  If  they  are,  a  strong 
ease  is  made  out  for  permanent  mental  retardation  or 
mental  deficiency.  If  doubt  still  exists,  the  next  step  in 
the  procedure,  or  the  mental  examination  proper,  must 
decide  it.  The  method  of  administering  these  tests  will 
be  described  in  the  next  chapter. 


VII. 

THE   METHOD   OF  CLASSIFYING  CLINIC  CASES 
(Concluded) 

The  last  chapter  carried  the  examination  through  the 
physical  tests  and  observations  and  up  to  the  mental  tests 
proper.  When  the  physical  examination  is  completed 
several  results  may  have  emerged.  First,  no  physical 
defect  may  have  been  found,  or,  at  least,  no  more  than 
would  be  expected  in  any  normal  child.  Thereupon  two 
possible  conclusions  are  open  to  the  clinician:  the  child 
may  be  normal  mentally  and  the  cause  of  his  backward- 
ness or  moral  deviation  be  due  to  environment  or  peda- 
gogical circumstances;  or,  he  may  be  mentally  deficient 
^^^th  no  physical  stigmata.  The  mental  tests  still  to  be 
given  must  determine  which  he  is. 

Secondly,  a  number  of  removable  physical  defects  may 
have  been  discovered,  any  or  all  of  them  of  such  nature 
that  their  presence  would  fully  account  for  the  mental 
or  moral  deviation  observed.  In  such  a  case  the  final 
judgment  must  be  held  in  reserve  and  the  child  must  be 
sent  to  various  medical  and  surgical  clinics  for  relief  and 
restoration  to  physical  health,  and  possibly  even  then 
some  special  pedagogical  training  and  observation  must 
be  added  before  the  final  conclusion  as  to  his  mentality 
can  be  reached. 

Thirdly,  a  number  of  congenital  phj-sical  defects  indi- 
cating retarded  or  abnormal  development  and  knouTi  by 
experience  to  be  always  associated  with  permanent  mental 
retardation  maj^  exhibit  themselves,  and  to  these  indica- 
tions certain  items  of  personal  and  family  history  may 

179 


180     THE  CONSERVATION  OF  THE  CHILD 

add  their  testimony.  Here,  as  in  the  first  supposition, 
the  mental  tests  must  be  again  appealed  to  for  final 
confirmation. 

The  Whole  Examination  is  to  Determine  Intelli- 
gence.— Though  we  have  spoken  of  the  mental  test  as 
succeeding  the  physical,  it  must  be  remembered  that  the 
whole  examination  is  in  a  sense  mental;  that  all  the  pre- 
vious inquiries  and  explorations  into  the  family  history, 
into  the  pedagogical  career  and  the  anatomy  and  physi- 
ology of  the  child  have  been  made  with  a  psychological 
motive  and  end  in  view,  namely, — a  decision  as  to  the 
transiency  or  permanency  of  the  underlying  causes  of 
backwardness  or  moral  transgressions.  Dulness  or 
amentia?  Mischief  or  moral  imbecility? — these  questions 
must  be  constantly  in  the  mind  of  the  operator  from  the 
first  moment  his  eyes  rest  upon  the  child  presented  for 
classification  to  the  last  test  he  can  bring  to  bear  upon  the 
case.  In  instances  of  marked  deficiency,  he  will  have 
decided  before  the  unfortunate  defective  has  taken  three 
steps  within  the  door,  by  the  first  keen  and  searching 
glance  at  the  evident  stigmata;  in  other  cases  of  border- 
land mentality  or  of  moral  delinquency  he  will  be  sifting 
and  weighing  evidence  against  evidence  through  many 
months  of  supervised  training. 

Mental  Tests  and  Their  Dangers. — The  mental  tests 
are  so  numerous  and  of  so  great  a  variety  that  the  reader 
is  referred  for  a  full  account  of  them  to  Whipple's  Manual 
of  Physical  and  Mental  Tests.  Many  of  these,  however, 
are  not  practical  for  application  to  the  clinic  work.  This 
is  a  fault  with  many  systems. 

This  much,  at  any  rate,  is  clear:  The  clinician  cannot 
ordinarily  make  use  of  an  elaborate  and  intricate  test. 
He  has  not  the  time  to  make  experiments,  nor  is  the  clinic 
the  place  for  experimentation.     Whatever  tests  he  uses 


CLASSIFYING  CLINIC  CASES  181 

must  be  simple,  comparatively  few  in  number  and  capable 
of  being  applied  quickly.  Probably,  too,  no  tests  will 
ever  be  developed  which  \vill  give  trustworthy  results 
when  operated  by  inexperienced  hands  and  minds.  Dr. 
Charles  S.  Myers,  of  Cambridge  University,  places  him- 
self upon  record  in  no  uncertain  terms  in  the  British 
Medical  Journal  as  wholly  opposed  to  hasty  standardizing 
of  mental  tests  and  the  ill-considered  popularizing  of  their 
use.   He  says  in  part: 

"I  want  to  protest  as  strongly  as  I  can  against  the 
notion  that  any  useful  purpose  can  be  served,  so  far  as 
psychology  is  concerned,  by  collecting  masses  of  psycho- 
logical data  with  the  help  of  an  army  of  untrained  ob- 
servers. But  I  will  leave  these  difficulties  on  one  side  and 
pass  on  to  the  other  purposes  of  this  wholesale  application 
of  'mental  tests.'  This  neglect  to  analyze  and  to  take 
heed  of  what  is  actually  being  measured  is  specially  prone 
to  occur  in  the  use  of  mental  tests.  In  other  sciences  there 
is  little  or  no  real  difficulty  in  observing  what  we  are 
measuring,  if  only  the  experimenter  t^ke  reasonable  care. 
But  in  psychology  we  can  only  ascertain  what  we  are 
testing  by  recourse  to  introspection  on  the  part  of  the 
subject.  To  neglect  introspection  in  psychological  experi- 
ments is  usually  to  court  certain  disaster.  If  we  are  in 
total  ignorance  of  what  has  been  going  on  in  the  mind  of 
the  subject  during  the  experiment,  it  is  rarely  possible 
to  argue  from  the  objective  data — from  the  measurements 
which  it  yields.  For  example,  we  may  be  trying  to  deter- 
mine whether  any  correlation  exists  between  sensory  dis- 
crimination and  general  intelligence.  A  positive  result 
may  be  simplj'^  due  to  the  fact  that  the  very  nature  of  the 
test  has  compelled  the  subject  to  use  his  intelligence  while 
carrying  out  sensory  discriminations.  We  may  be  corre- 
lating mental  ability  with  mental  fatigue,  and  neglect  the 


182     THE  CONSERVATION  OF  THE  CHH^D 

fact  that  sometimes  we  may  not  be  measuring  fatigue  at 
all;  that  in  some  subjects  the  task  becomes  automatic,  in 
others  tedious,  or  that  boredom  may  be  in  others  over- 
come by  motives  of  duty  or  ambition.  We  may  be  testing 
the  visual  acuity  of  two  persons  and  obtain  a  different 
result  from  each,  despite  the  fact  that  really  they  have  the 
same  visual  acuity.  The  result  may  be  due  to  the  fact 
that  the  one  subject  strains  every  effort  to  interpret  what 
he  but  dimly  sees,  while  the  other  only  reads  what  he 
believes  he  can  clearly  see.  Thus  again  we  merely  obtain 
a  blurred  or  erroneous  result  from  the  blind  applications 
of  statistical  methods  to  measurements  which  are  really 
meaningless  owing  to  our  failure  to  analyze  the  conditions 
determining  the  character  we  are  measuring. 

"For  these  reasons  I  urge  extreme  caution,  at  least  for 
the  present,  in  standardizing '  mental  tests '  and  in  popular- 
izing their  use.  In  some  forms,  no  doubt,  tests  can  be 
usefully  applied  en  masse — for  example,  with  the  object  of 
determining  the  standard  of  intellect  which  a  boy  of 
given  age  should  attain  in  order  to  class  him  as  suitable 
or  unsuitable  to  be  taught  in  an  'ordinary'  or  a  'special' 
school.  But  such  tests  are  'tests  of  production,'  not 
'mental  tests.'  They  determine  how  much  an  individual 
can  work,  how  much  he  knows — not  how  he  works,  how 
he  knows.  A  man's  productivity,  of  course,  is  what  we 
want  to  ascertain  in  everyday  life.  We  do  not  care  how 
a  man  comes  to  use  or  to  acquire  his  powers ;  we  are  con- 
tent with  a  mere  dynamometric  or  other  record  of  his 
prowess.  From  this  aspect  mass  experiments  must  have 
some  value.  But  this  aspect  can  not  properly  be  called 
the  psychological  aspect."  ^ 

1  Charles  S.  Myers,  The  Pitfalls  of  "Mental  Tests."  British 
Medical  Journal,  January  28,  1911. 


CLASSIFYING  CLINIC  CASES  183 

To  these  words  of  a  physician  must  be  added  the  cau- 
tions of  Binct,  the  elaborator  of  the  well-kno\vn  scale 
for  measuring  intelHgence.  "It  is  not,"  he  says,^  "in 
spite  of  appearances,  an  automatic  method,  comparable  to 
a  scale  which,  when  one  stands  up  on  it,  throws  out  a 
ticket  on  which  one's  weight  is  printed.  It  is  not  a  me- 
chanical method,  and  we  predict  to  the  busy  physician 
who  wishes  to  apply  it  in  hospitals  that  he  will  meet 
with  disappointments.  The  results  of  our  examinations 
are  of  no  value  if  they  are  separated  from  all  commentary; 
an  interpretation  is  necessary.  The  idea  that  a  method 
of  examination  can  be  made  precise  enough  to  be  trusted 
to  everyone  must  be  abandoned;  all  scientific  procedure 
is  but  an  instrument  which  requires  the  direction  of  an 
intelligent  hand." 

Two  Kinds  of  Tests  in  General. — As  intimated  in  Dr. 
Myers'  strictures,  there  are  two  chief  classes  of  mental 
tests  in  existence  designed  for  two  different  purposes.  One 
kind,  called  by  him  "tests  of  production,"  determines 
how  much  an  individual  knows,  and  therefore  his  fitness 
for  receiving  certain  kinds  of  pedagogical  mstructions. 
Such  tests  likewise  ascertain  his  place  in  everyday  life  as 
far  as  that  is  determined  by  his  mental  attainments.  In 
other  words,  to  the  clinician  such  tests  give  precise  infor- 
mation concerning  the  degree  of  pedagogical  retardation 
in  any  backward  child. 

It  must  be  remembered  that  this  information  is  not 
final  in  itself,  but  valuable  only  as  indicating  that  the 
child  who  falls  behind  his  fellows  while  working  under 
the   same    conditions  as   they,  must   have  within   him- 

*  Quoted  in  The  Binet-Simon  Scale  and  the  Psychologist,  by 
Clara  Harrison  Town.  The  Psychological  Clinic,  vol.  v,  No.  8, 
Jan.  15,  1912,  pp.  239,  240. 


184     THE  CONSERVATION  OF  THE  CHILD 

self  some  cause,  either  physical  or  mental,  for  his 
retardation. 

On  the  other  hand,  some  tests  are  designed  for  other 
ends.  They  enable  the  examiner  to  analyze  consciousness 
or  to  locate  the  cause  of  mental  retardation — after  such 
a  condition  is  discovered — in  some  mental  process  or 
group  of  processes.  They  reveal  how  the  mind  of  the 
subject  works  or  how  he  learns,  or  why  he  does  not  learn. 
For  clinic  purposes  each  test  has  its  use  and  its  place. 

The  Pedagogical  Tests. — Among  the  first  kind  of  tests 
we  have  found  by  actual  practice  in  the  Psychological 
Clinic  that  a  pedagogical  test  based  upon  the  regular 
public  school  examination  questions  holds  a  place  of  un- 
doubted value.  The  original  questions,  a  modification 
and  condensation  of  which  we  give  below,  were  taken  from 
the  Philadelphia  public  schools,  and  apply,  therefore,  to 
this  locality,  though  they  contain,  no  doubt,  material 
similar  to  that  used  in  other  schools.  One  of  their  claims 
to  consideration  rests  upon  their  availability  and  their 
practicality.  They  are  found  in  every  school  and  need 
but  slight  simplification  and  condensation  to  make  them 
suitable  for  clinical  use. 

Before  applying  them,  however,  their  purpose  must  be 
rigidly  defined.  If  they  are  forced  beyond  their  legitimate 
sphere,  they  may  work  harm;  but  if  their  full  significance 
is  not  understood  they  will  not  yield  as  much  information 
nor  play  as  important  a  role  in  diagnosis  as  they  justly 
deserve. 

They  serve,  in  the  first  place,  unless  the  question  has 

already  been  decided  by  the  oral  examination,  to  measure 

pedagogical  standing.    Hence,  as  we  have  said, 

Their   Place  \         °,  .  ,        ,  .,  ,  .,  i  •  i  j 

they  determme  whether  the  child  is  advanced  or 
retarded  mentally,  and  they  do  this  with  all  requisite 


CLASSIFYING  CLINIC  CASES  185 

accuracy  according  to  the  school  standard.  In  this  respect 
alone  their  use  in  a  psychological  clinic  is  fully  justified, 
for  it  is  surprising  how  difficult  (or  sometimes  impossible) 
it  is  by  questioning  to  determine  in  what  grade  any  par- 
ticular child  belongs.  Parents  confess  a  surprising  degree 
of  ignorance  on  the  subject  and  the  children  frequently  do 
not  possess  sufficient  mentality  to  give  more  than  vague 
and  unintelligible  answers.  To  have  at  hand  a  ready 
method  of  deciding  such  an  important  question  both  for 
classification  purposes  and  for  future  training  puts  the 
clinician  upon  a  firm  footing. 

But  beyond  the  measurement  of  general  retardation 
these  tests  determine  intellectual  attainments  already 
acquired  by  the  child.  Hence  they  give  some  indirect 
estimate  of  his  mental  capacity.  They  do  not  measure 
single  mental  processes,  it  is  true,  but  that  is  no  detriment 
at  this  stage  of  the  mental  examination,  which  is  concerned 
with  the  general  mental  status  of  the  child.  In  coming  to 
a  conclusion  on  this  point,  the  final  test  of  his  mental 
ability  is  his  general  reaction  toward  any  group  of  stimuli. 
How  well  he  accomplishes  his  assigned  tasks,  or  plays  his 
games,  or  is  able  to  acquire  the  ordinary  rudiments  of  an 
education  under  the  same  conditions  that  obtain  with 
normal  children, — how  much  he  produces,  as  suggested 
above, — are  of  far  more  importance  for  predicting  his 
mental  ability  to  hold  his  o\\'n  in  society  than  many  a 
fine-drawn  technical  test  worked  out  in  a  laboratory. 

Reading  as  a  Mental  Test.— Readmg  is  a  good  ex- 
ample of  such  a  general  test.  To  a  trained  observer 
the  very  way  the  child  picks  up  a  book  and  holds  it  is 
highly  significant.  He  may  immediately  exhibit  many 
signs  of  muscular  coordination.  The  utterance  of  the 
first  words  tells  much  more  in  the  same  direction.    He  may 


186     THE  CONSERVATION  OF  THE  CHILD 

mumble,  stammer,  mutter,  stutter,  hesitate,  or  else  he 
may  proceed  articulately,  fluently,  distinctly  with  the 
proper  intonations  and  emphases.  The  finer  muscular 
coordinations  necessary  for  clear  pronunciation  are  ex- 
ceedingly delicate  registers  of  that  "tone"  so  strikingly 
characteristic  of  the  normal  child  in  contrast  with  that 
flabbiness  belonging  to  every  muscular  and  mental  effort 
of  the  subnormal.  The  sensory  faculties  as  well  as  the 
motor  are  being  tested  at  the  same  moment.  The  child 
hardly  needs  to  read  a  line,  or  even  a  word,  in  order  to 
furnish  the  attentive  observer  with  some  data  as  to  his 
visual  acuity.  This  appears  from  the  position  of  his  book, 
the  position  of  his  head,  the  squint  of  his  eyes,  the  wrinkles 
on  his  forehead,  the  way  he  follows  words,  lines  or  letters. 
The  distance  of  his  book  from  his  face  may  reveal  myopia 
or  hypermetropia ;  the  wrinkles  tell  of  eye-strain,  headaches 
and  the  traditional  "bilious  attacks";  the  tilt  of  the  head 
may  be  an  attempt  to  eliminate  or  suppress  the  image  of 
one  eye.  Not  long  ago,  at  the  clinic,  almost  total  blind- 
ness in  one  eye  of  a  backward  boy,  undergoing  a  long 
treatment  for  defective  audition,  was  discovered  by  the 
simple  process  of  closing  the  eyes  alternately  while  he  was 
reading  from  an  ordinary  school-book. 

When  the  command  is  given  for  the  child  under  obser- 
vation to  read  and  while  the  reading  is  going  forward 
much  can  be  learned  of  his  general  disposition  and  atti- 
tude toward  his  tasks.  He  may  act  immediately,  willingly, 
smilingly,  briskly;  or  he  may  hang  back,  scowl,  move 
slowly  with  reluctance,  awkwardness  and  ungraciousness 
in  every  movement.  He  may  meet  new  words  by  an 
attempt  to  pronounce  them,  or  spell  them,  or  may  come 
to  a  dead  halt  and  wait  inertly  until  they  are  pronounced 
for  him.    He  may  take  no  interest  in  the  story,  tire  quickly 


CLASSIFYING  CLINIC  CASES  187 

and  let  his  attention  wander;  or  he  may  gain  interest 
with  every  line,  become  absorbed  and  show  evident 
pleasure  in  the  task.  While  none  of  these  indications  are 
final  for  determining  his  mental  status  nor  even  de- 
cisive for  judging  his  attitude  toward  the  larger  tasks 
of  life,  they  are  still  weighty  factors  in  deciding  on  both 
of  these  points,  and  their  weight  will  depend  to  a  large 
extent  upon  the  acuteness  of  the  observer  and  his 
experience  in  summing  up  these  ordinary  expressions 
of  character. 

The  contribution  made  to  the  observer's  knowledge  of 
the  mental  acquisitions  of  the  child  is  of  course  the  primary 
object  of  the  exercise.  It  reveals  at  once  whether 
the  child  can  read  or  not ;  that  is,  whether  at  least  what  is 
he  can  pronounce  printed  words  or  not.  How  well 
he  can  do  this  is  showm  by  manner  of  reading, — whether 
he  proceeds  slowly,  hesitatingly,  monotonously  without 
inflection,  emphasis,  cadence  or  expression,  or  easily, 
fluently,  and  intelligently.  A  few  judicious  questions  at 
the  end  will  reveal  something  of  his  ability  to  recall  the 
words,  to  remember  what  he  has  read  in  general  terms  or 
in  his  own  words  and  to  understand  the  nature  of  what  he 
has  read,  which  in  itself  will  give  some  hints  as  to  his 
powers  of  imagination  and  his  general  information  as  well 
as  his  ability  to  gather  information  from  symbols.  Thus 
by  having  him  read  a  few  paragraphs  much  evidence  can 
be  collected  upon  a  child's  muscular  co-ordination,  his 
general  attitude  and  disposition,  his  intellectual  attain- 
ments and  his  mental  capacities.  His  intellectual  powers, 
his  emotions  and  his  will  are  all  involved  in  the  simple 
task.  Sensation,  perception,  imagination,  memory  and 
reason,  in  varying  degrees,  are  investigated  and  each  one 
furnishes  its  quota  of  information.    In  all  of  these  respects 


188     THE  CONSERVATION  OF  THE  CHILD 

what  he  does  not  know  or  is  not  able  to  do  is  as  important 
as  what  he  does  know  or  do. 

Arithmetic  as  a  Test. — In  a  Hke  manner  we  might 
go  through  each  one  of  the  pedagogical  tasks  of  the  test 
and  indicate  how  rich  and  varied  is  the  information  to  be 
gathered  through  their  correct  use.  Much  must  be  left 
for  the  clinician  to  elaborate  for  himself.  Arithmetic,  of 
course,  enlarges  the  observer's  information  upon  the 
reasoning  powers  of  the  child  and  settles  the  question  of 
ability  to  grasp  abstract  numerical  relations.  With  some 
the  passage  from  the  concrete  to  the  abstract  is  impossible 
and  marks  a  permanent  defect.  If  the  problems  are 
spoken,  care  must  be  taken  to  note  the  child's  auditory 
acuity;  if  they  are  written,  his  reading  ability  is  again 
taken  into  account. 

Oral  Dictation  as  a  Test. — In  oral  dictation,  in  which 
he  writes  down  sentences  read  for  him,  the  pupil's  auditory 
acuity  for  daily  sounds,  his  auditory  memory,  his  skill  in 
writing  demanding  some  of  the  most  complex  coordina- 
tions, and  his  ability  to  express  knowledge  by  means  of 
symbols  all  come  out.  Spelling,  or  writing  single  dictated 
words  tries  his  memory  again  from  a  new  angle  in  its 
simple  physiological  aspect.  Throughout  his  powers  of 
attention — the  sine  qua  non  of  all  learning — have  been 
tested  in  their  various  forms  and  phases. 

The  Educability  of  the  Child. — Finally,  the  pedagogi- 
cal examination  furnishes  testimony  upon  one  question 
of  supreme  importance  in  the  classification,  viz.,  the 
educability  of  the  child.  The  question  is  not  only  primary 
in  diagnosis,  but  of  vital  import  for  all  future  training. 
If  by  the  pedagogical  examination  the  child  in  question 
shows  that  he  has  been  able  to  acquire  even  the  rudiments 
of   reading,   writing   and   arithmetic   by   the  prevailing 


CLASSIFYING  CLINIC  CASES  189 

methods  of  the  ordinary  school-room,  it  proves  that  he 
possesses  ability  to  learn  out  of  books.  He  is  able  to 
absorb  symbolic  knowledge.  His  education  need  not  be 
confined  to  the  physiological  method  or  to  motor  expres- 
sions alone.  He  not  only  receives  sensory  impressions  but 
translates  them  into  meaning  for  his  life  and  well-being. 
He  apperceivcs  in  a  sense  and  by  methods  which  lift  him 
at  once  into  a  comparativc^ly  high  mental  position  and 
promises  hope  for  the  future.  His  learning  may  be  com- 
paratively small  in  amount  and  his  progress  may  be 
greatly  retarded,  but  the  examiner  familiar  with  the  situa- 
tion sees  there  the  germ  of  potentialities  yet  undeveloped 
and  is  able  to  predict  with  some  accuracy  to  what  extent 
these  powers  may  be  developed  by  more  intense  methods 
of  individual  instruction  than  those  possible  in  the  school- 
room. Probably  then  it  is  not  too  much  to  say  that  by 
the  observation  of  the  way  in  which  a  child  reacts  to  the 
pedagogical  tests,  taken  in  conjunction  with  all  the  pre- 
ceding information  gained  from  the  oral  and  physical 
examinations,  the  trained  examiner  who  is  familiar  with 
these  tests  will  be  able  to  gauge  the  general  intellectual 
capacity  of  a  pupil  with  sufficient  exactness  to  assign  him 
to  the  class  of  curable  or  incm-able  mental  deviates  to 
which  he  belongs  and  to  the  sub-class  of  aments  if  he  is 
found  to  be  of  that  company.  To  substantiate  his  classi- 
fication, it  must  be  remembered,  he  still  has  other  tests, 
both  pedagogical  and  of  different  kinds  yet  to  be  described. 
The  pedagogical  tests  in  use  at  the  Psychological  Clinic 
at  the  University  of  Pennsylvania  are  given  below.  As 
already  stated,  they  were  secured  from  the  public  schools 
and  were  modified  to  suit  the  conditions  in  hand.  Four 
grades  of  reading,  writing,  arithmetic,  dictation,  and 
spelling  are  given.     The  normal  child  should  secure  at 


190     THE  CONSERVATION  OF  THE  CHILD 

least  75  per  cent,  in  each  branch  of  study  in  the  grade 
corresponding  to  his  age,  assuming  that  he  began  school 
at  six  years  and  was  promoted  each  year. 

SECOND  GRADE 

Reading.     (8  years  old.) 

Directions. — Give  a  maximum  of  40  credits  for  reading  the  words 
correctly,  including  articulation  and  pronunciation,  and  60  credits 
for  expres.sion  and  natural  rendering  of  the  thought.  The  child's 
knowledge  of  the  meaning  may  be  ascertained  by  conversation,  or 
by  judicious  questioning. 

MY  DOG  SPOT. 

1.  My  dog  Spot  knows  a  great  deal.  I  think  he  knows 
almost  as  much  as  I  do.  He  knows  more  than  I  do  about 
some  things. 

When  we  are  away  off  in  the  woods,  and  I  cannot  find 
the  way  home,  I  follow  Spot.  I  say  to  him,  "Go  home. 
Spot!"  He  looks  at  me,  and  then  off  he  goes.  He  always 
goes  straight  home. 

2.  I  think  he  knows  some  things  I  say  to  him.  When  I 
say,  "Sit  up.  Spot!"  he  sits  up  as  straight  as  a  man,  and 
holds  out  one  paw  as  if  to  shake  hands.  When  I  say, 
"Roll  over!"  down  he  goes  and  rolls  over  and  over.  If  I 
tell  him  to  lie  dead,  he  will  shut  his  eyes  and  lie  still,  and 
not  open  his  eyes  even  if  I  pull  him  by  the  tail. 

SECOND  GRADE 
Spelling  and  Dictation.     (8  years  old.) 

Directions. — Exercise  No.  1.  100  credits.  Deduct  5  for  every 
error.  Dictate  a  sentence  at  a  time.  A  long  sentence  may  be  given 
in  two  parts.  Avoid  repetition.  The  exercise  is  to  be  written  but 
once. 

Exercise  No.  2.  100  credits.  10  for  each  word.  If  the  meaning 
is  not  clear,  a  word  may  be  repeated  in  a  sentence. 


CLASSIFYING  CLINIC  CASES 


191 


Exercise  No.  1. 

William  Brown  has  a  pet  monkey.  He  is  a  very  funny 
little  fellow.  He  likes  to  do  what  he  sees  people  do.  He 
soon  learned  to  eat  with  a  spoon  and  a  fork.  He  drinks 
from  a  cup. 


Exercise  No.  2. 
butter 
apples 
coffee 
fruit 
pencil 


basket 

father 

draw 

cunning 

snow 


SECOND  GRADE 

Arithmetic.     (8  years  old.) 

Exercises  for  Rapid  Work:     100  credits.     10  credits  each. 
Directions. ~\.  When  a  child  counts  on  his  fingers  give  no  credit 
for  the  result. 

2.  The  child  should  not  be  allowed  to  use  written  work  in  any 
form  as  an  aid  in  making  the  calculations.  No  alterations  or  cor- 
rections are  to  be  permitted. 

3.  The  questions  in  1  to  10  are  intended  for  rapid  work.  Results 
not  given  promptly  are  of  no  value. 

1.  Write  in  figures  689. 

2.  Write  in  Roman  numerals  11. 

3.  19  plus  7  equals? 

4.  7  times  9  equals? 

5.  48  divided  by  8  equals? 

6.  How  many  days  in  9  weeks? 

7.  %  of  36  equals? 

8.  3  dozen  pencils  are  how  many? 

9.  What  is  the  cost  of  8  oranges  at  4  cents  a  piece? 
10.  Place  the  hour  hand  on  the  clock  face  between  3 

and  4  and  the  minute  hand  at  6.    Require  the  child  to  tell 
the  time. 


192     THE  CONSERVATION  OF  THE  CHILD 

Written  Work:     100  units;     20  units  each. 

Directions. — 1.  Place  problem  4  on  the  paper  in  the 
form  in  which  it  is  stated  on  this  paper ;  do  not  subdivide 
the  credits. 

2.  In  problems  5,  6,  and  7,  give  no  credit  if  the  principle 
is  not  correct ;  give  half  the  credits  if  the  principle  is  cor- 
rect and  the  work  incorrect. 

3.  Place  each  example  on  paper  and  read  it  to  the  child. 
After  allowing  a  reasonable  time  to  perform  the  problem, 
erase  it  before  proceeding  to  the  next. 

1.  Subtract  235  from  763. 

2.  978  divided  by  6  equals? 

3.  John  bought  a  cap  for  48  cents,  a  penknife  for  25 
cents  and  a  ruler  for  5  cents.  How  much  did  he  pay  for 
all? 

4.  A  storekeeper  sells  pineapples  at  6  cents  each.  How 
much  will  he  get  for  14  pineapples? 

5.  A  storekeeper  sells  his  small  flags  at  5  cents  a  piece. 
How  many  can  you  buy  for  65  cents? 

THIRD  GRADE 

Reading.     (9  years  old.) 

Directions. — Give  a  maximum  of  40  credits  for  reading  the  words 
correctly,  including  articulation  and  pronunciation,  and  60  credits 
for  expression  and  natural  rendering  of  the  thought.  The  child's 
knowledge  of  the  meaning  may  be  ascertained  by  conversation  or 
by  judicious  questioning. 

HOW  TWO  BOYS  GOT  SCARED. 

We  waded  up  the  brook  until  we  got  into  the  woods. 
It  was  very  lonely.  All  at  once  we  heard  a  terrible  splash- 
ing.   "  What  is  that?  "  said  Jimmy. 

"I  guess  it's  our  bear,"  said  I.  "Now  you  look  him 
firmly  in  the  eye,  and  he  will  slink  away." 


CLASSIFYING  CLINIC  CASES  193 

"Don't  you  think  it  would  be  bott^^r  to  climb  a  tree?" 
said  Jimmy  in  a  shaky  voice. 

The  splashing  came  nearer  and  nearer.  "  Perhaps  you 
can  run  away  if  he  stops  to  eat  me,"  said  Jimmy.  Then 
I  felt  bold  as  a  lion.  "He  shan't  eat  you,  Jim;  I  will  hit 
him  with  ray  fist." 

"Bow- wow- wow!"  said  a  voice  that  we  knew  well. 
Then  our  old  dog  Carlo  came  dashing  through  the  bushes. 
I  tell  you  we  were  glad  to  see  him. 

THIRD  GRADE 

SPEiaLiNG  AND  DICTATION.      (9  years  old.) 

Directions. — Exercise  No.  1.  100  credits.  Deduct  5  for  every 
error.  Dictate  a  sontonce  at  a  time.  A  long  sentence  may  be  given 
in  two  parts,  .\void  repetition.  The  exercise  is  to  be  written  but 
once. 

Exercise  No.  2.  100  credits.  10  for  each  word.  If  the  meaning 
is  not  clear,  a  word  may  be  repeated  in  a  sentence. 

Exercise  No.  1. 

One  morning  Mrs.  Johnson,  a  farmer's  wife,  was  pre- 
paring to  make  the  butter  at  the  back  of  the  house.  The 
house  stood  near  the  edge  of  the  woods.  She  had  just  put 
the  cream  into  the  churn  and  had  gone  away. 

Exercise  No.  2. 

oranges  people 

cabbage  Atlantic  Ocean 

playthings  weather 

breathing  pitcher 

wholesome  naj^kin 

THIRD  GRADE 

Arith.\ietic.     (9  years  old.) 

Exercises  for  Rapid  Work: — 100  credits.    10  for  each  problem. 
Directions. — Dictate  every  question  in  these  exercises.    No  ques- 
tion or  part  of  a  question  is  to  be  written. 
13 


194     THE  CONSERVATION  OF  THE  CHILD 

The  cliild  is  not  to  be  allowed  to  use  written  work  in  any  form 
or  as  an  aid  in  making  the  calculations.  No  alterations  or  correc- 
tions are  to  be  permitted. 

The  questions  in  1  to  10  are  intended  for  rapid  work.  Restilts  not 
given  promptly  are  of  no  value. 

1.  Write  in  figures  72307. 

2.  Write  in  Roman  numerals  38. 

3.  17  plus  8  plus  10  equals? 

4.  9  times  8  minus  20  equals? 

5.  99  divided  by  11  plus  16  equals? 

6.  ?^  of  27  equals? 

7.  How  many  weeks  in  a  year? 

8.  How  many  inches  in  4  feet  and  6  inches? 

9.  How  many  pounds  in  a  ton? 

10.  What  part  of  a  dollar  is  25  cents? 

Written  Work: 

1.  92041  minus  45629  equals? 

2.  53840  divided  by  76  equals? 

3.  Change  760  ounces  to  pounds  and  ounces. 

4.  How  much  change  would  you  get  from  a  two-dollar 
bill  after  buying  3  bushels  of  potatoes  at  55  cents  a  bushel? 

5.  A  grocer  had  54  watermelons.  He  sold  %  of  them. 
How  many  had  he  left? 

FOURTH  GRADE 

Reading.     (10  years  old.) 

Directions. — Give  a  maximum  of  40  credits  for  reading  the  words 
correctly,  including  articulation  and  pronunciation,  and  60  credits 
for  expression  and  natural  rendering  of  the  thought.  The  child's 
knowledge  of  the  meaning  may  be  ascertained  by  conversation  or 
by  judicious  questioning. 

JOHN  LARKIN'S  LESSON. 
1.  John  Larkin  was  a  little  boy  who  was  fond  of  seeing 
things  grow.     He  had  a  pretty  little  garden,  where  he 


CLASSIFYING  CLINIC  CASES  195 

could  see  the  tiny  plants  come  up  from  the  seeds  which 
he  had  planted. 

2.  By  the  side  of  the  garden,  with  a  fence  between,  was 
a  yard  for  the  hens  and  chickens.  He  saw  the  hens  go  to 
their  nests  and  lay  their  eggs.  Each  hen  laid  one  egg 
almost  every  day;  and  soon  after  the  egg  was  laid  the 
hen  came  off  the  nest,  sometimes  quietly,  but  nearly 
always  cackling. 

FOURTH  GRADE 

Spelling  and  Dictation.     (10  years  old.) 

Directions. — Exercise  No.  1.  100  credits.  Deduct  5  for  each 
error.  Dictate  a  sentence  at  a  time.  A  long  sentence  may  be  given 
in  two  parts.  Avoid  repetition.  The  exercise  is  to  be  written  but 
once.  Exercise  No.  2.  100  credits.  lOfor  each  word.  If  the  meaning 
is  not  clear,  a  word  may  be  repeated  in  a  sentence. 

Exercise  No,  1. 

CLOUDS. 

William's  mother  was  talking  about  the  rain.  "Is  the 
rain  in  drops  up  in  the  clouds,  mother,  or  is  it  all  in  one, 
like  a  pond  of  water?"  asked  William.  His  mother 
replied,  "It  is  in  drops  so  very  small  that  we  may  call 
them  rain  dust  or  water  dust." 

Exercise  No.  2. 

tangle  custard 

vinegar  funeral 

tomatoes  Delaware  River 

alligator  bicycle 

continue  oyster 

FOURTH  GRADE 

Akithmetic.     (10  years  old.) 

Directions. — 100  credits.    10  for  each  problem. 
Dictate  every  question  in  these  exercises.     No  question  or  part 
of  question  is  to  be  written. 


196     THE  CONSERVATION  OF  THE  CHILD 

The  child  is  not  to  bn  allowed  to  use  wTitten  work  in  any  form 
as  an  aid  in  making  calculations.  No  alterations  or  corrections  are 
to  be  permitted. 

The  child  should  be  required  to  number  the  questions  as  dictated, 
and  to  ^Tite  the  final  results  only,  as  soon  as  obtained. 

Questions  in  Nos.  1  to  10  are  intended  for  rapid  work.  Results 
not  given  promptly  are  of  no  value. 

Exercises  for  Rapid  Work: 

1.  Write  in  figures  307649. 

2.  Write  in  Roman  numerals  175. 

3.  27  plus  17  minus  14  equals? 

4.  81  divided  by  9  plus  17  equals? 

5.  K  of  48  plus  24  equals? 

6.  K  plus  %  equals? 

7.  How  many  cubic  inches  in  a  cubic  foot? 

8.  Write  3  prime  numbers  larger  than  7. 

9.  2  quarters  and  2  dimes  are  how  many  cents? 
10.  How  many  cubic  feet  in  2  cubic  yards? 

Exercises  for  Written  Work: 

The  following  problems  may  be  placed  on  the  paper  one 
at  a  time. 

100  credits.    20  for  each  problem. 

1.  If  4  gallons  of  oil  cost  80  cents,  what  will  Yi  of  a 
gallon  cost? 

2.  Multiply  4%  by  12. 

3.  Divide  %  by  %. 

4.  How  many  square  inches  in  4  square  yards,  6  square 
feet  and  66  square  inches? 

5.  Make  out  the  following  bill  and  receipt  it: — 

5  bushels  potatoes  at  75  cents  a  bushel. 
8  baskets  tomatoes  at  60  cents  a  basket. 

6  baskets  peaches  at  85  cents  a  basket. 


I 


CLASSIFYING  CLINIC  CASES  197 

FIFTH  GRADE 
Reading.     (U  years  old.) 

Directions. — Give  a  maximum  of  30  credits  for  reading  the  words 
corrt3Ctly,  including  articulation  and  pronunciation,  and  70  credits 
for  e.\pr(\s.sion  and  natural  rendering  of  the  thought.  The  child's 
knowledge  of  the  meaning  may  be  ascertained  by  conversation,  or 
by  judicious  questioning. 

THE  BRAVE  MOTHER. 

A  little  wren  made  her  nest  in  a  tree  in  my  yard.  She 
protected  it  from  the  cats  by  building  it  far  out  on  a  slender 
branch.  She  hid  it  from  all  prying  eyes  by  placing  it  on 
the  side  nearest  the  house  and  farthest  from  the  path. 

Searching  one  day  for  some  blossoms  of  the  honey- 
suckle that  grew  against  the  wall,  I  discovered  the  nest. 
It  had  three  tiny  eggs  in  it.  The  mother-bird  had  been 
sitting  on  the  nest,  but  she  flew  away  at  mj'^  approach. 
Day  after  day  I  watched  her  sitting  patiently  on  that 
nest.  Finally  her  patience  was  rewarded,  and  three  little 
wrens  nestled  under  her  wings. 

FIFTH  GRADE 
Spelling  and  Dictation.     (11  years  old.) 

Directions. — Exercise  No.  1.  100  credits.  Deduct  5  for  each 
error.  Dictate  a  sentence  at  a  time.  A  long  sentence  maj'  be  given 
in  two  parts.    Avoid  repetition. 

Exercise  No.  2.  100  credits.  10  for  each  word.  Dictate  each 
word  but  once.  If  the  meaning  is  not  clear,  a  word  may  be  repeated 
in  a  sentence. 

Exercise  No.  1. 

JOE'S  CONFESSION. 
Joe  had  played  a  mean  trick  on  old  Mr.  Jackson.     He 
had  thought  it  was  fun,  but  now  he  felt  uiihapi)y.     Joe 
went  to  old  Mr.  Jackson  and  asked  to  be  forgiven.     Do 
you  think  that  was  easy  for  Joe? 


198     THE  CONSERVATION  OF  THE  CHILD 


Exercise  N'o.  2. 

excursion 

delicious 

particular 

bribery 

salary 

bishop 

physician 

telephone 

nourish 

FIFTH 

GRADE 

question 

Arithmetic. 

(11  years 

old.; 

1 

For  Rapid  Work: 

Directions. — The  child  should  not  be  allowed  to  use  written  work 
in  any  form  as  an  aid  in  making  the  calculations. 

Results  not  obtained  and  recorded  promptly  are  of  no  value. 

100  credits.     10  for  each  problem. 

1.  Subtract  .8  from  2.5.    Give  answer  as  decimal. 

2.  What  are  the  prime  factors  of  12? 

3.  %  minus  ]i  equals  ? 

4.  %  times  %  equals  ? 

5.  How  many  square  feet  in  \]i  square  yards? 

6.  At  $5  per  dozen  what  will  48  shovels  cost? 

7.  How  many  hours  in  b%.  days  ? 

8.  Reduce  1%  to  sixths. 

Written  Work:    100  credits      20  for  each  problem. 

The  analysis  of  problem  3  is  to  be  written  out  in  full. 
Give  no  credit  if  the  principle  is  not  correct. 

In  problems  4  and  5  give  no  credits  if  the  principle  is 
not  correct.  Give  half  the  credits  if  the  principle  is  correct 
and  the  work  is  incorrect. 

1  If  %  of  a  bushel  of  barley  costs  45  cents,  what  will 
6/^  bushels  cost? 

2.  Multiply  the  sum  of  2^,  5K  and  7%  by  12. 

3.  A  lady  bought  5  yards  of  cloth  at  $1.25  per  yard, 
8K  doz.  buttons  at  72  cts.  per  doz.  and  4  collars  at  $1.12}^ 
each.    She  paid  cash.    Make  out  a  bill  and  receipt  it. 


CLASSIFYING  CLINIC  CASES  199 

4.  At  $1.50  per  square  rod,  what  will  2  acres  of  land 
cost  ?     Reduce  2052G  feet  to  higher  denominations. 

5.  A  coal  dealer  sold  3  carloads  of  coal  weighing  36.625, 
28.25  and  42.87  tons  at  S6.40  per  ton.  What  was  the 
total  amount  of  the  sale? 

Non-Pedagogical  Tests.— Manifestly,  pedagogical  tests 
are  suited  only  to  those  children  who  have  attended  school 
for  some  period  of  time.  For  those  who  are  too  young, 
or  for  those  who  because  of  any  reason  whatever  have 
been  unable  to  attend  school,  a  system  of  tests  has  also 
been  formulated.  These,  like  the  pedagogical  tests,  are 
general,  in  that  each  of  them  involves  a  great  many  mental 
processes,  and  also,  in  that  they  measure  the  general 
attitude  of  the  child  toward  a  task.  They  are  not  peda- 
gogical in  the  sense  that  they  have  been  taken  from  the 
regular  scholastic  tests  of  the  school-room,  though  some 
of  them  for  children  above  the  school  age  involve  certain 
acquirements  usually  obtained  in  the  school-room,  like 
reading,  writing  and  arithmetic.  From  the  name  of  their 
originator  these  are  called  the  Binet  tests,  which  are 
being  so  wdely  applied  both  to  the  problems  of  retarda- 
tion in  the  school-room  and  to  the  problem  of  examining 
mentally  defective  children  in  the  various  institutions. 
For  the  latter  purpose,  though  the  tests  were  originally 
formulated  for  the  children  in  the  French  school,  several 
modifications  have  been  made  to  fit  American  conditions. 

The  Binet  Scale. — It  is  neither  our  task  nor  our 
province  to  enter  upon  an  extended  criticism  of  the  Binet- 
Simon  scale.  One  or  two  cautions,  however,  appear 
necessary  in  this  place.  They  concern  both  the  method 
of  applying  the  scale  and  the  results  to  be  obtained  by 
its  use. 

Concerning  the  former,  Binet,  himself  not  only  gave 


200     THE  CONSERVATION  OF  THE  CHILD 

some  general  advice  applying  to  all  tests  but  added  specific 
injunctions  concerning  the  use  of  his  own  scale.  "The 
results  of  our  examinations,"  he  is  reported  as  saying,^ 
"  are  of  no  value  if  they  are  separated  from  all  commentary; 

an  interpretation  is  necessary The  microscope  and 

the  graphic  method  are  admirable  methods  of  precision, 
but  what  intelligence,  circumspection,  erudition,  and  art 
are  essential  to  the  practice  of  these  methods!  Imagine 
the  value  of  observations  made  with  the  microscope  by 
an  ignoramus  scarcely  better  than  an  imbecile.  We  have 
seen  examples  which  caused  us  to  shudder."  Others  have 
added  similar  words  of  caution  like  the  following: 

"In  conclusion,  I  would  urge  that  these  Binet  tests 
must  be  used  with  judgment  and  trained  intelligence,  or 
they  will  certainly  bring  themselves  or  their  authors  into 
undeserved  disrepute.  Such  a  syllabus  as  is  here  presented 
by  no  means  prepares  mothers  and  teachers  to  make  any 
valid  test  either  of  their  children  or  of  the  scale.  A  child 
will  often  be  shown  to  have  the  knowledge  needed  in  a 
test  which  is  not  of  knowledge  merely,  but  of  the  ability 
to  use  knowledge  in  meeting  a  situation  created  by  the 
standardized  conditions  of  the  test.  Results  can  be  con- 
sidered valid  only  when  the  tests  are  made  by  an  experi- 
enced psychologist  who  has  familiarized  himself  with 
Binet's  directions,  or  by  other  competent  persons  who 
apply  the  tests  under  the  directions  and  supervision  of 
such  a  psychologist."* 

The  Purpose  of  the  Binet  Tests. — The  purpose  to 
be  accomplished  by  the  Binet  tests  must  be  clearly  de- 

3  The  Psychological  Clinic,  vol.  v,  No.  8,  Jan.  15,  1912.  The 
Binet-Simon  Scale  and  the  Psychologist,  Clara  H.  Town,  pp.  239,  240. 

*  E.  B.  Hucy,  The  Binet  Scale  for  Measuring  Intelligence  and 
Retardation,  Jour,  of  Educational  Psychology,  vol.  i,  No.  8,  Oct., 
1910. 


CLASSIFYING  CLINIC  CASES  201 

fined  by  the  examiner.  It  certainly  does  not  seem  too 
much  to  say  that  incurable  mental  retardation  of  certain 
degrees  cannot  be  distinguished  from  curable  mental 
retardation  by  the  Bini^t  tests  alone.  They  may  test  the 
degree  of  mental  retardation  of  a  child  with  great  ease 
and  with  as  much  exactness  as  do  the  pedagogical  tests. 
But  the  degree  of  retardation,  except  in  unusual  cases, 
like  that  of  Kaspar  Hausc^r,  for  example,  does  not  deter- 
mine mental  deficiency  in  our  sense  of  the  term.  Two 
boys,  each  eleven  years  of  age,  could  conceivably  measure 
up  to  only  seven  years  by  the  Binet  tests.  Each  would 
be  three  years  retarded.  Yet  one  might  be  mentally 
defective  and  the  other  only  retarded.  The  first  might 
have  been  developed  by  wise  training  to  his  full  capacities. 
The  second  might  be  retarded  as  far  as  responses  to  mental 
tests  go,  both  in  his  intellectual  attainments  and  in  his 
mental  capacities.  But  if  his  physical  defects — his  mal- 
nutrition, his  poor  vision,  bad  audition,  deteriorated 
dentition,  infected  tonsils — if  these  were  all  remedied, 
as  they  might  be,  there  is  no  reason  for  assuming  that 
he  could  not  develop  to  the  mental  stature  of  a  fall- 
grown  man.* 

*  For  a  fuller  study  of  the  Binet  tests  sec  articles  by  Binet 
and  Simon,  Les  Enfants  Anormaux,  1905  and  1907;  L'Annec  Psy- 
chologique,  1908  and  1911;  La  Mesurc  du  Developpmcnt  de  I'intel- 
ligence  cliez  Ics  jeunes  enfants,  Bulletin  de  la  societe  libre  pour 
I'etude  psychologique  de  I'enfant,  April,  1911,  pp.  187-284. 

For  translations  and  criticisms  of  the  scale,  see  articles  by  Henry 
Goddard,  Two  Thousand  Normal  Children,  Measured  by  the  Binet 
Measuring  Scale  of  Intelligence,  Pedagogical  Scyiimari/,  June,  1911, 
vol.  xxviii,  No.  2,  pages  2I32-25G;  Binet's  Measuring  Scale  of  Intel- 
ligence, The  Training  Schonl,  vol.  vi,  No.  2;  A  Revision  of  the 
Binet  Scale,  The  Training  School,  vol.  viii,  No.  4,  pages  56-62; 
Leonard  P.  Ayres,  The  Binet-Simon  Scale  for  Measuring  Intelligence: 
Some  Criticisms  and  Suggestions,  The  Psijchologirnl  Clinic,  vol.  v. 
No.  G,  pages  187-196,  incl.  O.  Dcroly  and  Mile.  J.  Degrand, 
La  Mesurc  de  rintelligence  Chez  des  Enfants  Normaux  e'Apres  lea 


202     THE  CONSERVATION  OF  THE  CHILD 

This  restriction  does  not  at  all  require  the  eHmination 
of  the  Binet  tests  from  mental  examinations.  It  merely 
points  out  what  Binet  himself  said,  ncamely,  that  the  scale 
is  not  an  automatic,  registering  machine  which  announces 
a  decision  regarding  a  child's  mental  status  with  mechani- 
cal certainty.  That  decision  must  be  reserved  for  the 
operator,  and,  in  making  it,  he  must  take  into  considera- 
tion many  other  of  the  subject's  reactions  besides  those 
appearing  in  his  oral  or  written  answers  and  in  his  pre- 
scribed acts.  When  this  is  done  by  a  skilled  operator 
the  tests  become  immediately  valuable.  They  are  simple, 
easy  to  apply,  few  in  number,  require  little  apparatus, 
and,  best  of  all,  give  their  results  in  terms  of  normal  age 
easily  understood  by  all  concerned.  They  can  be  looked 
upon  as  so  many  partial  but  fairly  accurate  descriptions 
of  normal  children  of  different  ages.  With  these  cautions 
and  commendations  we  are  ready  to  consider  the  tests 
themselves.  They  are  here  arranged,  as  we  use  them 
in  the  clinic,  in  convenient  parallel  columns  giving  first 
the  test  and  the  method  of  fulfilling  it  immediately  oppo- 
site. A  report  blank  is  also  attached  for  announcing 
the  results. 

Directions  for  Giving  Binet  Tests. — The  following 
directions  for  administering  the  tests  were  formulated  by 
Binet  himself  and  should  receive  the  most  careful  perusal 
by  anyone  who  expects  to  obtain  valid  results  by  their 

Tests  de  MM.  Binet  et  Simon,  Nouvelle,  Contribution  Critique, 
Archives  de  Psychologic,  vol.  ix,  Jan.,  1910,  pages  81-108.  Miss 
Katharine  L.  Johnston,  M.  Binet's  Method  for  the  Measurement  of 
Intelligence: — Some  Results,  Journal  of  Experimental  Pedagogy 
and  Training  School  Record,  vol.i.  No.  1,  pp.  24-31.  Otto  Bobertag, 
Ueber  Intelligenz  Prufung  (nach  der  Methods  von  Binet  und  Simon), 
Zeitschrift  fur  angewandte  Psychologic,  vol.  v,  No.  2,  1911,  pp. 
10.5-203;  The  Binet  Scale  and  the  Psychologist,  Clara  H.  Town, 
The  Psychological  Clinic,  vol.  v,  No  8,  pp.  239-245. 


CLASSIFYING  CLINIC  CASES  203 

use.  So  much  confusion  and  so  much  discussion  has 
arisen  in  America  concerning  the  meaning  and  the  use  of 
the  measuring  scale  and  what  it  will  and  will  not  do,  that 
it  was  thought  best  to  give  these  directions  just  as  their 
author  himself  states  them,  omitting  only  some  unim- 
portant details. 

"Commence  with  each  subject  by  using  the  tests  de- 
signed for  his  age.  If  too  difficult  tests  are  tried  at  first 
he  is  discouraged.  If,  on  the  contrary,  they  are  too  easy, 
he  grows  disdainful,  wonders  whether  he  is  being  made  fun 
of  and  makes  no  effort. 

"In  reference  to  the  experimenter  himself,  some  con- 
ditions are  necessary.  He  must  not  allow  himself  to  be 
prejudiced  by  information  obtained  from  other  sources. 
He  should  banish  from  his  mind  all  that  he  has  been  told 
concerning  the  child  and  consider  him  as  an  x,  which  he 
must  solve  with  the  means  in  his  power.  He  should  be 
firmly  convinced  that  in  using  the  method  one  must 
necessarily  gain  a  profound  knowledge  of  the  child,  and 
so  entirely  ignore  all  other  information 

"This  initial  period  lasts  for  at  least  five  or  six  seances 
of  two  hours  each,  and  represents  examinations  of  twenty 
children.  All  experimenters  intending  to  use  the  method 
should  submit  to  such  a  preparation. 

"The  tests  should  be  prepared  in  advance;  the  little 
material  required  should  be  close  at  hand;  all  the  required 
coins  should  be  kept  in  a  special  purse.  Two  records 
should  be  kept:  the  first  recording  the  numerical  results 
of  the  tests,  and  the  second,  a  note-book,  recording  the 
responses  in  detail.     .     .     . 

"Opposite  the  test  names  the  results  are  expressed  by 
the  following  symbols:  the  +  sign  indicates  that  the  test 
is  passed;  the  sign—  indicates  failure;  the  sign  0  indicates 


204     THE  CONSERVATION  OF  THE  CHILD 

a  silence;  the  sign?  indicates  that  the  result  is  doubtful; 

if  a  doubtful  result  is  nearer   failure  than  success  the 

signs  —  ?  are  used;   if  it  is  nearer  success  the 

signs  +  ?.     When  the  result  is  excellent  we  use 

a  cross  ( +  !)  and  !,  and  when  it  is  altogether  bad  —  !. 

"We  advise  that  the  sign  be  recorded  immediately  the 
test  is  completed,  not  after  the  examination  upon  the 
reading  of  the  notes.  One  can  understand  why  we  so 
advise.  In  recording  a  symbol  we  do  not  register  auto- 
matically what  takes  place,  but  we  record  a  judgment, 
and  this  is  more  recent.  No  matter  how  detailed  the 
notes,  they  reproduce  but  very  incompletely  the  actual 
experience.  An  enormous  amount  of  detail  is  omitted,  as 
a  matter  of  course,  to  be  supplied  by  the  memory  of  the 
experimenter,  and  it  would  be  wrong  to  trust  entirely  to 
the  notes. 

"Having  marked  the  results  of  the  tests  by  signs,  more 
extended  notes  are  recorded  in  the  note-book.  This 
should  contain  the  full  name  of  the  child,  his  age,  date  of 
birth,  the  date  and  place  of  examination,  the  quality  of 
the  assistants  and  any  exceptional  circumstance  influencing 
the  examination. 

"The  notes  relative  to  each  test  which  should  be  re- 
corded in  this  book. — Experience  is  the  best  teacher  of  what 
is  useful  to  preserve.  It  is  necessary  to  bear  in  mind  that 
the  symbol  alone  is  altogether  insufficient,  and  that  we 
should  have  sufficient  data  to  enable  another  experi- 
menter to  judge  of  them  on  his  own  account.  Thus,  in 
the  responses  to  the  question  involving  the 
reason  powers,  the  manner  in  which  the  child 
explains  or  criticises  the  absurdities  of  certain  phrases 
must  bo  given  at  length.  In  using  the  test  requiring  the 
repetition  of  figures  it  is  well  to  have  model  series  and  not 


CLASSIFYING  CLINIC  CASES  205 

to  vary  them.  Then  what  the  child  gives  may  be  recorded. 
This  precaution  ■will  guard  against  the  possible  loss  of 
interesting  facts.  For  example,  the  experimenter  recites: 
1-3-9-2-7.  The  child,  believing  himself  repeating,  says: 
1-3-4-5-6.  The  error  is  very  grave,  graver  than  had 
he  said  1-3-8-5-0.  For  in  the  first  repetition  he  has 
followed  the  natural  order  of  numbers,  and  by  so  doing 
has  implicitly  admitted  the  absurdities  that  he  has  been 
asked  to  repeat  numbers  in  their  natural  order.  A  little 
commentary  helps  to  fix  results  in  memory.  The  defini- 
tions of  words  and  objects  and  the  resume  of  the  thought 
should  be  written  in  detail.  In  the  test  calling  for  60 
words  it  is  sometimes  difficult  to  write  all  the  words  given 
by  the  child.  Interesting  indications  can,  however,  always 
be  secured.  For  example,  each  word  may  be  represented 
by  a  vertical  line,  and  a  new  group  be  started  every  half 
minute  (the  total  test  lasts  three  minutes).  Thus  a 
record  is  secured  of  the  number  of  words  WTitten  in  the 
first  half  minute,  the  number  in  the  second,  the  number 
in  the  third,  etc.  This  shows  whether  the  subject  has 
increased  or  decreased  in  speed  as  the  experiment  pro- 
gressed, and  this  in  turn  gives  some  indication  of  his 
ability  to  work.  I  am  also  in  the  habit  of  dotting  the 
lines  which  correspond  to  the  names  of  objects  mentioned 
and  of  underlining  those  which  stand  for  an  unusual 
word,  one  not  in  common  use.  We  advise  that  the  rhymes 
be  recorded  and  also  the  sentence  containing  the  three 
given  words.  By  exacting  all  these  notes  from  collabora- 
tors it  is  possible  to  judge  with  what  care  the  experiments 
have  been  made.  A  record  of  the  intellignece  of  a  child, 
presented  without  other  data  than  some  symbols,  cer- 
tainly seems  subject  to  doubt.  It  cannot  be  tolerated; 
it  would  encourage  negligence  and  even  fraud. 


206     THE  CONSERVATION  OF  THE  CHILD 

"Utilization  of  notes. — We  have  recorded  a  series  of 
signs  in  vertical  columns ;  these  signs  succeed  each  other 
irregularly.  Here  there  is  a  — ,  there  +.  How  shall  we 
interpret  them?  It  is  at  once  evident  that  no  matter 
how  the  tests  are  arranged  it  is  impossible  to  find  an  order 
in  which  one  test  will  mark  the  limit  of  achievement,  all 
te?ts  preceding  it  being  passed  successfully  and  all  those 
following  being  too  difficult.  Such  an  order  can  easily  be 
arranged  for  one  individual,  but  it  would  not  prove  satis- 
factory for  a  second  and  a  third. 

"Let  us  examine  the  effect  of  the  order  which  we  have 
adopted,  as  shown  in  an  examination  of  10  children,  nine 
years  of  age.    In  the  tests  for  the  ninth  year  which  amount 
to  50  (as  there  are  5  tests  and  10  pupils)  these  ten  children 
failed  in  6  and  succeeded  in  44.    In  the  tests  for  the  tenth 
year,  they  failed  in  14  and  succeeded  in  36.    We  do  not 
find  a  limiting  test  which  fails  all  and  which  only  fails 
children  of  this  age  or  younger.    That  would  be  a  useful 
criterion,  but  we  have  not  discovered  it  and  do 
Counting"     not  belicve  that  it  exists.    The  actual  result  is  less 
simple.     The  experiment  shows  us  the  following 
facts.    The  nine-year-old  children  succeeded  in  all  the  very 
simple  tests  and  they  succeeded  in  none  of  the  very  difficult 
ones.     In  the  tests  of  moderate  difficulty  some  children 
succeeded  with  certain  tests  and  some  children  with  others. 
This  varied  with  each  child.    This  is  the  fact  which  we  are 
obliged  to  consider.    Each  child  has  its  own  individuality; 
one  succeeds  well  with  test  A  and  fails  with  test  B ;  another 
of  the  same  age  fails  the  test  A  and  succeeds  test  B.    How 
shall  we  deal  with  these  individual  differences  in  our 
experimental  results?    We  have  no  exact  knowledge  con- 
cerning the  cause.    It  is  probable  that  the  mental  faculties 
stimulated  by  the  tests  differ  and  are  of  an  unequal 


CLASSIFYING  CLINIC  CASES  207 

developm(3nt  in  different  children.  If  a  child  has  a 
better  memory  than  his  companions,  it  is  natural  for 
him  to  be  more  successful  in  a  test  of  simple  repe- 
tition. Another  who  has  already  a  capable  hand  will 
arrange  the  weights  more  successfully.  Another  reason 
is  that  all  of  our  tests  presuppose  an  effort  of  atten- 
tion and  the  attention  varies  during  our  tests.  We 
also  presuppose  an  effort  during  a  period  of  concentra- 
tion, especially  with  young  people:  now  it  is  intense; 
a  minute  later  it  is  relaxed.  Suppose  that  the  subject 
has  a  moment  of  distraction,  of  embarrassment,  of 
ennui  during  a  test.  Complete  failure  may  result.  One 
cannot  doubt  the  justice  of  this  last  reason.  We  are 
so  convinced  on  this  point  that  we  think  it  chimerical 
and  absurd  to  judge  the  intelligence  of  a  child  by  one 
test  alone. 

"The  preceding  considerations  lead  us  to  the  conclusion 
that  the  intellectual  level  of  a  child  can  be  judged  only  by 
a  group  of  tests.  It  is  success  in  several  distinct  tests 
which  alone  is  characteristic.  Intelligence  cannot  be 
estimated  as  can  the  height 

"It  is  altogether  other\vise  when  we  estimate  the  intel- 
ligence. If  one  wishes  to  apply  the  same  system  of  com- 
parison between  the  intelligence  of  one  child  and  the  mean 
intelligence  of  children  of  different  ages  one  is  hindered 
by  the  difficulty  which  we  have  mentioned  above.  A 
child  is  retarded  for  certain  tests  of  his  own  age  and  ad- 
vanced for  others.  We  think,  however,  that  this  difficulty 
can  be  overcome;  but  it  is  on  condition  chat  we  adopt 
some  convention;  and  the  said  convention,  be  it  the  best 
possible,  will  always  give  to  the  proceeding  an  artificial 
character.  If  by  chance  another  convention  has  been 
adopted  sensibly  different  results  would  have  been  reached. 


208     THE  CONSERVATION  OF  THE  CHILD 

We  feel  it  necessary  to  insist  on  this  fact,  because  later, 
for  the  sake  of  simplicity  of  statement,  we  will  speak  of 
a  child  of  eight  years  having  the  intelligence  of  a  child  of 
seven  or  of  nine  years. 

"  These  expressions  if  accepted  arbitrarily  may  cause 
errors.  If  accepted,  it  is  necessary  to  remember  that  the 
estimate  of  the  amount  of  retardation  or  precocity  of 
intelligence  depends  partially  upon  the  conventional  pro- 
ceeding which  we  have  adopted. 

"The  rules  which  we  apply  are  two.  The  first  we  have 
adopted  is  as  follows:  A  child  has  the  intelligence  of 
that  age  all  the  tests  for  which  he  succeeds  in  passing. 
Here  is  a  child  nine  years  of  age  who  passes  all 
Counting  the  tcsts  for  the  seventh  year.  He  has  then 
at  least  the  intelligence  of  a  child  of  seven. 
The  second  rule  is  as  follows:  After  determining 
the  age  for  which  a  child  has  passed  all  the  tests,  a 
year  is  added  to  the  intelligence  age,  if  he  has  suc- 
ceeded in  passing  five  additional  tests  belonging  to 
superior  age  groups;  two  years  are  added  if  he  has 
passed  ten  such  tests,  three  years  if  he  has  passed  fifteen, 
and  so  on. 

"Thus  a  child  has  passed  the  five  tests  for  the  eighth 
year;  he  has  the  intelligence  of  eight  years.  In  addition 
he  has  passed  three  tests  for  nine  years  and  two  tests  for 
ten  years.  We  add  one  year  for  the  five  tests,  the  record 
stands  8  and  1  make  9,  and  the  child  has  an  intelligence 
of  nine  years.  Another  example:  A  child  has  passed  the 
5  tests  for  6  years;  he  has  the  intelligence  of  G  years. 
He  also  passed  3  tests  for  7  years,  3  for  8  years,  2  for  9 
years,  2  for  10  years,  and  1  for  11  years.  This  gives  him 
11  extra  tests,  and  adds  2  years  to  his  intelligence  age, 
making  it   8  years.      A  last   example:     A  child  passed 


CLASSIFYING  CLINIC  CASES  209 

all  the  tests  for  4  years,  he  passed  in  addition  1  test 
for  5  years,  3  for  0  years,  2  for  7  years,  4  for  8  years, 
3  for  9  years,  2  for  10  years;  he  has  then  15  additional 
tests,  which  is  equivalent  to  3  years,  and  he  is  accorded 
the  mental  age  of  7. 

"The  result  of  this  notation  is  that  it  qualifies  a  child 
as  regular  in  intelligence  if  it  has  an  intelligence  age  equal 
to  its  age;  as  advanced  in  intelligence  if  it  has  an  intelli- 
gence 1  or  2  years  greater  than  its  age,  and  as  re- 
tarded in  intelligence  if  it  has  an  intelligence  1  or  2 
years  inferior  to  its  age.  The  symbols  used  to 
express  the  results  are:  =,  or  +1,  +2,  +3,  etc.; 
or,  —  1,-2,-3,  etc. 

"We  would  add  that  a  child  should  not  be  considered 
defective  in  intelligence,  no  matter  how  little  he  knows, 
unless  his  retardation  of  intelligence  amounts  to  more 
than  two  years. 

"If  a  child  is  to  be  examined  a  second  time  it  is  best, 
in  order  to  guard  against  the  coaching  of  the  child  by  his 
companions,  to  allow  a  period  of  at  least  G  months  to 
intervene  between  the  examinations. 

"A  last  word  for  those  persons  who  desire  to  employ 
the  method.  Any  one  can  use  it  for  his  own  personal 
satisfaction  or  to  obtain  an  approximate  evaluation 
of  a  child's  intelligence,  but  for  the  results  of  this 
method  to  have  a  scientific  value  it  is  absolutely 
necessary  that  the  individual  who  uses  it  should  have 
served  an  apprenticeship  in  a  laboratory  of  pedagogy'  or 
possess  a  thorough  practical  knowledge  of  psychological 
experimentation."  " 


•  For  this  translation  I  am  indebted  to  Dr.  Clara  H.  Town, 
Psychologist  at  the  State  School  for  Feeble-minded,  Lincoln,  III. 
14 


210     THE  CONSERVATION  OF  THE  CHILD 


REPORT  BLANK  FOR  THE  BINET  TEST. 

Name Made  by 

Bom Date 

Test  Age 


Remarks: 

Six  Years: 

Ten  Years: 

1. 

1. 

2. 

2. 

3. 

3. 

4. 

5. 

4.  1st  series  a 
b 
c 

Remarks: 

2nd  series  a 
b 
c 
d 

Three  Years: 

Seven  Years: 

e 

1. 

i. 

5. 

2. 

2. 

3. 

3. 

Remarks: 

4. 

4. 

5. 

5. 

Eleven  Years: 

Remarks: 

Remarks: 

l.a 
b 
c 
d 

Four  Years: 

Eight  Years: 

e 

1. 

1. 

2. 

2. 

2. 

3. 

3. 

3. 

4. 

4. 

4. 

5.  a 

5. 

5. 

b 

c 

Remarks: 

Remarks: 

Remarks : 

Five  Years: 

Nine  Years: 

Twelve  Years 

1. 

1. 

1. 

2. 

2. 

2. 

3. 

3. 

3. 

4. 

4. 

4. 

5. 

5. 

5. 

Remarks: 

Remarks: 

Remarks : 

CLASSIFYING  CLINIC  CASES  211 

BINET  TESTS 
Children  of  Three  Years. 

1.  Where  is  your  nose?    Your  eyes?    Your  mouth? 

One  of  the  best  signs  of  awakening  intelhgence  in  young 
children  is  the  comprehension  of  spoken  words.  We  test 
by  asking  these  questions  which  can  be  answered  by  a 
gesture. 

2.  Repetition  of  sentences  of  six  syllables. 

It  rains.  I  am  hungry.  (6  syllables.)  Experiment 
proves  that  it  is  easier  for  a  child  to  repeat  words  than  to 
speak  a  word  of  his  own.  If  a  child  does  not  respond  one 
may  try  him  with  two  syllables  ("7nama"),  then  four,  etc. 
A  child  of  three  repeats  six  syllables  but  not  ten.  There 
must  not  be  a  single  error. 

3.  Repetition  of  figures.    "6-4." 

A  child  of  three  can  repeat  two  figures.  Figures  require 
closer  attention  than  words  because  they  mean  nothing  to 
him.  Pronounce  the  figures  distinctly,  one-half  second 
apart,  and  without  emphasis  on  any  one  figure. 

4.  Describing  pictures. 

A  picture  is  shoun  to  the  child  with  the  question, 
"What  do  you  see.?"  The  pictures  must  be  chosen  with 
some  care.  Each  one  must  represent  some  people  and  a 
situation.  Binet  uses  three  pictures.  The  first  is  a  man 
and  a  boy  drawing  a  cart  loaded  with  furniture.  The 
second,  a  woman  and  a  man  sitting  on  a  bench  in  a  park 
in  winter.  The  third,  a  man  in  prison  looking  out  of  the 
window;  a  couch,  chair  and  tables.  A  child  of  three  names 
the  things — enumerates.  He  does  not  describe  any  actions 
in  the  pictures. 

5.  Name  of  the  family. 

All  children  of  three  know  the\v  first  name.  They  some- 
times know  the  family  name,  bat  not  always. 


212     THE  CONSERVATION  OF  THE  CHILD 

Children  of  Four  Years. 

1.  Sex  of  child. 

Are  you  a  little  boy  or  a  little  girl?  If  testing  a  girl,  give 
the  question  in  this  form:    Are  you  a  girl  or  a  boy? 

2.  Naming  familiar  objects. 

One  takes  from  his  pocket  a  key,  a  knife,  and  a  penny. 

The  answers  should  indicate  that  the  child  knows  what 
each  is.  This  is  more  difficult  use  of  language  than  naming 
the  objects  in  the  picture,  because  there  the  child  chose 
his  own  object  to  name;  here  we  say,  "  What  is  this  thing? ^' 

3.  Repetition  of  three  figures.    "7-2-9." 

4.  Comparison  of  two  lines.     "Which  is  the  longer  line?" 
Draw  two  parallel  lines  three  centimetres  apart,  the  one 

five  centimetres  and  the  other  six.     Hesitation  is  failure. 

Children  of  Five  Years. 

1.  Comparison  of  two  weights.    "  Which  is  the  heavier?" 
Use  weighted  blocks  of  wood  of  equal  size  and  appearance. 
Compare  three  grammes  with  twelve  grammes  and  six 

grammes  with  fifteen  grammes.     Note  the  curious  and 
interesting  errors  that  are  made. 

2.  Copying  a  square. 

Draw  a  square  of  three  or  four  centimetres.  Have  the 
child  copy  it  with  ink — not  pencil.  Pen  makes  it  harder. 
It  is  satisfactory  if  one  can  recognize  the  square. 

3.  Repeat  sentence  of  10  syllables. 

Use  this :    His  name  is  John.    He  is  a  very  good  boy. 

4.  Counting  four  pennies. 

Place  four  pennies  in  a  row.  Insist  that  child  count 
them  with  his  finger. 

At  three  years  a  child  does  not  know  how  to  count  four: 
at  four  half  succeed:    at  five  all  succeed. 

5.  Game  of  patience  with  two  pieces. 

Cut  a  visiting  card  diagonally.  Place  a  whole  card  on 
the  table.    Nearer  the  child  place  the  two  pieces  with  the 


CLASSIFYING  CLINIC  CASES 


213 


^V 


<^:^  .£ottd/  Uaic^ 


^U3- 


I 

Materials  for  Binet  Tests. 
A— For  8-year,  No.  4  -p  f  For  lo-year,  No.  2 

B— For  4-year,  No.  4  I  For    5-veai,No.  5 

C— For  5-year,  No.  2  F— For    S-vear,  No.  5  (1908  ed.) 

D— For  7-year,  No.  4  G-H  — For  10-year,  No.  2 

I — For    7-year,  No.  5 


214     THE  CONSERVATION  OF  THE  CHILD 

two  hypothenuses  away  from  each  other.  Ask  the  child  to 
make  a  figure  hke  the  uncut  card.  One  child  in  twelve  fails. 
Be  careful  (1)  that  the  child  does  not  fail  because  he 
is  too  indolent  to  reach  out  and  try :  (2)  that  one  of  the 
two  pieces  does  not  get  turned  over — because  then  it  is 
impossible:  (3)  that  you  do  not  show  by  a  look  whether 
the  child  is  right  or  wrong. 

Children  of  Six  Years. 

1.  Distinction  between  morning  and  afternoon. 

"Is  this  morning  or  is  it  afternoon?''  It  should  be  re- 
membered that  a  certain  type  of  child  will  always  answer 
the  last  of  two  alternatives.  Therefore  if  the  time  is 
afternoon,  it  is  well  to  put  the  question,  "Is  this  afternoon 
or  morning?"    Not  before  six  do  children  know  this. 

2.  Definition  of  known  objects. 

"What  is  a  fork?  a  table?  a  chair?  a  horse?  a  mama?" 

There  are  three  kinds  of  response.  (1)  Silence,  simple 
repetition  or  gesture,  e.g.,  "A  fork  is  a  fork,"  or  pointing 
says  "That  is  a  chair."  (2)  Definition  in  terms  of  use, 
"A  fork  is  to  eat  with."    (3)  Definition  better  than  by  use. 

This  includes  all  answers  that  describe  the  thing  or 
even  begin  with  "it  is  a  thing" — "it  is  an  animal,"  etc., 
all  of  which  expressions  are  not  so  childlike  as  the  simple 
"use"  definitions. 

In  deciding  which  type  of  answer  we  shall  credit  to  the 
child,  we  accept  three  out  of  five.  At  four  and  a  half  the 
children  define  by  "use":  it  increases  a  little  at  five  and 
at  six  practically  all  define  this  way.  Not  before  nine  do  the 
majority  give  the  definitions  that  are  "better  than  by  use." 

3.  Execution  of  three  simultaneous  commissions. 

"Do  you  see  this  key?     Put  it  on  that  chair.     Then  shut 
the  door.    After  that  bring  me  the  box  that  is  on  the  chair. 
"Remember,  first  the  key  on  the  chair,  then  close  the  door, 


CLASSIFYING  CLINIC  CASES 


215 


Fig.  2. 


Esthetic  comparison.    Used  for  G-year-old  Binet  test. 


216     THE  CONSERVATION  OF  THE  CHILD 

then  bring  the  box.  Do  you  understand?  Well,  then,  go 
ahead."  Such  are  the  directions.  They  must  all  be  done 
without  further  help,  hint  or  suggestion.  At  four  years 
almost  none  can  do  this,  at  five  about  half:  at  six  all,  or 
nearly  all,  succeed. 

4.  Right  hand.    Left  ear. 

One  says  to  child  "Show  me  your  right  hand"  and  when 
this  is  done,  "Show  me  your  left  ear."  There  are,  in  the 
main,  three  kinds  of  response.  (1)  Does  not  know  right 
and  left.  Shows  right  hand  because  of  natural  tendency. 
Shows  right  ear  also.  (2)  Knows  but  is  not  sure.  Shows 
right  hand,  then  right  ear,  but  corrects  himself  at  once. 
(3)  Knows  and  without  hesitation  touches  right  hand  and 
left  ear.  (2)  and  (3)  are  considered  satisfactory.  If  child 
touches  one  hand  with  the  other  in  such  a  way  that  one 
cannot  tell  which  hand  he  means,  ask  him  to  hold  his  right 
hand  up  high.  Be  very  careful  in  this  test  to  give  no  hint 
by  look  or  word.  At  four  years  no  child  points  to  left  ear: 
at  five  half  of  the  children  make  a  mistake :  at  six  all  succeed. 

5.  Esthetic  comparison. 

"  Which  is  the  prettier?" 

Binet  uses  six  heads  of  women  in  three  pairs,  the  one 
pretty  and  the  other  ugly  or  even  deformed  (Fig.  2).  Care 
is  taken  that  the  pretty  one  is  now  at  the  left  and  now  at 
the  right.    At  six  all  choose  correctly :    at  five  about  half. 

Children  of  Seven  Years. 
1.  Counting  thirteen  pennies. 

Pennies  must  be  placed  in  a  row  and  counted  with  the 
finger.  Finger  must  touch  the  piece  at  the  same  time  that 
the  child  names  the  number.  No  piece  must  be  counted 
twice  and  none  omitted.  The  number  thirteen  must  be 
given  exact.  At  six  years  two-thirds  fail:  at  seven  they 
make  no  errors. 


CLASSIFYING  CLINIC  CASES  217 


Fio.  3. 


Unfinished  pictures.     Used  for  7-year-oId  Binet  test. 


218     THE  CONSERVATION  OF  THE  CHILD 

2.  Description  of  pictures. 

Same  picture  as  used  in  age  of  three.  Child  now  de- 
scribes things  instead  of  simply  enumerating. 

3.  Unfinished  pictures. 

One  shows  four  sketches  as  Fig.  3.  Ask  the  child  "  What 
is  lacking  in  that  picture?"  Child  must  answer  three  out 
of  four  correctly.  At  five  years  none  are  correct:  at  six 
errors  number  two-thirds:  at  seven  the  great  majority  are 
accurate. 

4.  Copying  a  diamond. 

Draw  a  rhombus  about  the  size  of  the  square  used  for 
age  five.  Have  child  copy  this  with  pen.  The  result  is 
satisfactory  if  it  would  be  recognized  as  intended  for  a 
diamond-shaped  figure. 

5.  Name  four  colors. 

Use  red,  blue,  green  and  yellow  papers,  in  pieces  about 
1X3  inches.  Touching  each  color  with  the  finger  ask 
"  What  is  that  color?"  It  will  be  seen  this  is  a  test  of  color 
names,  not  of  discrimination.  It  should  be  done  in  six 
seconds. 

Children  of  Eight  Years. 

1.  Compare  two  things  from  memory. 

"What  is  the  difference  between  a  butterfly  and  a  fly?" 
"Wood  and  glass?"  "Paper  and  pasteboard?  (or  cloth?)" 
The  question  may  be  differently  put  so  as  to  make  it 
intelligible  as  possible,  e.  g. ,   "  Why  are  they  not  alike?  "  etc. 

Two  at  least  out  of  the  three  pairs  should  be  answered 
correctly.  If  it  takes  more  than  two  minutes  it  is  a  failure. 
At  six  a  third  of  the  children  do  this  test:  at  seven  nearly 
all:  at  eight  all. 

2.  Count  backward  from  20  to  1. 

This  should  be  done  within  20  seconds,  and  only  one 
mistake  allowed  of  omission  or  transposition. 


CLASSIFYING  CLINIC  CASES  219 

3.  The  days  of  the  week. 

These  must  be  given  in  order  without  omission  within 
ten  seconds.  Most  persons  would  expect  that  this  could 
be  done  before  the  ago  of  nine,  but  it  cannot. 

4.  Count  nine  "Sous"  (3  simples  and  3  doubles). 

(Our  two-cent  piece  is  now  so  rare  that  we  use  1-cent 
and  2-cent  postage  stamps.) 

Arrange  in  order,  1,  1,  1,  2,  2,  2.  ''How  much  are  they 
worth?  (How  much  money  to  buy  them?)  ''Count." 
It  should  be  done  Avithin  ten  seconds  Avithout  any  error. 

There  are  three  ways  of  counting.  (3ne  child  says 
1,  2,  3,  5,  7,  9.  Another  says  1,  2,  3,  4-5,  6-7,  8-9.  The 
third  says,  1,  2,  3,  4,  5,  6,  which  is  of  course  wrong.  A 
large  majority  do  this  test  at  seven  years;  but  all  do  it 
at  eight. 

5.  Repetition  of  five  figures. 

"4-7-3-9-5."     Same  method    of   procedure   as   given 

above,   age  three.     Only   three-fourths   of  the  children 

succeed. 

Children  of  Nine  Years. 

1,  Make  change — 9  cents  out  of  25: 

Play  store,  using  real  money.  If  child's  cash  consists 
of  25  pennies,  5  nickels,  and  2  dimes,  interesting  degrees 
of  intelligence  will  be  discovered  by  noticing  the  coins  he 
uses  in  making  the  change.  Child  is  storekeeper.  One 
buys  something  that  costs  9  cents.  Child  must  actually 
give  16  cents  as  well  as  say  it. 

At  seven  no  one  can  do  this  test :  at  eight  a  good  third 
succeed:    at  nine  all  do  it.    (See  Revision.) 

2.  Definition  better  than  by  "Use." 

This  was  explained  under  age  six.  At  ages  seven  and 
eight  half  the  children  give  definitions  of  this  kind.  At 
nine  they  all  do. 


220     THE  CONSERVATION  OF  THE  CHILD 


3.  Name  the  day  of  the  week,  the  month,  the  day  of  the 

month  and  the  year. 
The  test  is  passed  even  if  the  day  of  the  month  is  as 
much  as  three  days  wrong.     Children  least  often  know 
the  year. 

4.  The  months  of  the  year : 

Recited  in  order  within  15  seconds.  Allow  one  omission 
or  transposition. 

5.  Arrangement  of  weights : 

Use  five  wooden  cubes  of  same  size  and  appearance 
but  loaded  so  as  to  weigh  6,  9,  12,  15,  18  grammes.  (Metal 
pill  boxes  may  be  used.)  Place  the  five  boxes  on  table  in 
front  of  child  and  explain  that  they  do  not  all  weigh  aUke 
and  he  is  to  lift  them  one  at  a  time  and  put  them  in  order 
from  the  lightest  to  the  heaviest.  (The  initial  of  each 
weight  written  on  the  bottom  of  each  box  makes  it  easy 
to  see  if  they  are  right.)  Record  the  exact  order  in  which 
the  child  has  placed  them.  Three  trials  are  made.  Two 
must  be  absolutely  correct.  The  whole  operation  must 
not  take  over  three  minutes. 

Children  of  Ten  Years. 

1.  Naming  nine  pieces  of  money: 

One  may  use  cent,  nickel,  dime,  quarter,  half  dollar, 
dollar,  two  dollars  and  ten  dollars. 

Pieces  should  be  on  the  table  in  a  row,  but  not  in  regular 
order  of  value.    Point  with  finger,  and  name  as  he  points. 

2.  Draw  design  from  memory: 


H 

1— 

CLASSIFYING  CLINIC  CASES  221 

3.  Repeat  six  figures : 
854726,  274681,  941738. 

4.  Questions  of  comprehension : 

First  Series. 

What  ought  one  to  do : — 

1.  When  one  has  missed  the  train? 

2.  When  one  has  been  struck  by  a  playmate  who  did 
not  do  it  on  purpose? 

3.  When  one  has  broken  something  that  does  not  belong 
to  one? 

At  seven  and  eight  half  respond  correctly:  at  nine 
three-fourths:  at  ten  all.  If  two  questions  out  of  three 
are  answered  correctly  the  test  is  passed. 

Second  Series. 

What  ought  one  to  do : — 

1.  When  ho  is  detained  so  that  he  uill  be  late  for 
school? 

2.  What  ought  one  do  before  taking  part  in  an  important 
affair? 

3.  Why  does  one  excuse  a  wrong  act  committed  in 
anger  more  easily  than  a  WTong  act  committed  without 
anger? 

4.  What  should  one  do  when  asked  his  opinion  of  some 
one  whom  he  knows  only  a  little? 

5.  Why  ought  one  to  judge  a  person  more  by  his  acts 
than  by  his  words? 

Allow  at  least  20  seconds  to  each  question.  Three  of 
the  five  must  be  answered  correctly.  At  seven  and  eight 
no  one  responds  to  a  majority  of  this  second  series:  at 
ten  half  are  successful;  it  is  therefore  a  transition  between 
ten  and  eleven  years. 


222     THE  CONSERVATION  OF  THE  CHILD 

5.  Using  three  words  in  a  sentence: 

Binet  uses  the  words  Paris,  fortune,  river.  We  should 
say  Philadelphia,  money,  river.  This  is  the  first  time  in 
these  tests  that  we  have  required  a  child  to  "invent"  his 
own  expressions.  There  are  three  forms  of  answers. 
(1)  Three  separate  sentences.  (2)  Ideas  united  by  a 
conjunction.  (3)  A  single  idea  involving  the  three  words. 
Only  the  last  two  are  satisfactory  for  the  test.  We  allow 
one  minute.  At  eight  no  one  succeeds.  At  nine  one-third 
and  at  ten  one-half  get  it  right. 

In  this  test  may  be  seen  a  distinction  between  intelli- 
gence and  judgment.  Some  children  give  a  complete 
sentence  with  the  three  words  but  they  do  not  make 
sense. 

Children  of  Eleven  Years. 

1.  Criticism  of  sentences : 

These  are  sentences  that  contain  some  absurdity  or 
ridiculous  expression.  Binet  explains  that  formerly  he 
used  sentences  like  '^ Is  snow  red  or  black?"  but  he  found 
that  many  bright  children  fell  into  the  trap  and  others 
through  confidence  in  the  questioner  failed  to  look  for  an 
absurdity.  Therefore  he  has  changed  the  plan  and  now 
says  to  the  child,  "I  am  going  to  give  you  some  sentences  in 
which  there  is  some  nonsense.  You  are  to  listen  carefully 
and  see  if  you  can  tell  me  where  the  nonsense  is."  Then  he 
reads  the  sentence  very  slowly. 

1.  "An  unfortunate  cyclist  has  had  his  head  broken  and  is 
dead  from  the  fall;  they  have  taken  him  to  the  hospital  and 
they  do  nst  think  that  he  will  recover." 

2.  "/  have  three  brothers:    Paul,  Ernest  and  myself." 

3.  "  The  police  found  yesterday  the  body  of  a  young  girl 
cut  into  eighteen  pieces.    They  believe  that  she  killed  herself." 


CLASSIFYING  CLINIC  CASES  223 

4.  "  Yesterday  there  was  an  accident.  But  it  was  not 
serious:    the  number  of  deaths  is  only  48." 

5.  Some  one  said,  "//  in  a  moment  of  despair  I  should 
commit  suicide,  I  shoidd  not  choose  Friday,  because  Friday 
is  an  unlucky  day  and  it  would  bring  me  ill-luck." 

The  test  should  last  about  two  minutes.  Three  at 
least  of  the  questions  should  receive  good  answers.  At 
nine  yeaxs  hardly  any  child  gets  them:  at  ten  scarcely  a 
fourth :  at  eleven  a  half. 

2.  Three  words  in  a  sentence: 

(Given  under  ten  years.)    At  eleven  all  succeed. 

3.  Sixty  words  in  three  minutes. 

"Say  as  many  words  as  you  can  in  three  minutes;  as 
table,  board,  beard,  shirt,  carriage."  We  tell  him  that 
some  children  have  named  200  words. 

This  test  gives  a  splendid  opportunity  to  appreciate 
the  intelligence  of  a  child.    At  least  60  words  must  be  given. 

4.  Rhymes: 

Explain  what  is  meant  by  one  word  rhyming  with 
another.  Illustrate.  Then  ask  for  as  many  words  as  the 
child  can  think  of,  that  rhyme  with  a  given  word,  e.g., 
day,  or  spring,  or  mill. 

One  minute  is  allowed.  Three  rhymes  with  one  word 
should  be  found  in  the  given  time. 

5.  Words  to  put  in  order : 

"Make  a  sentence  out  of  these  words," 

Hour — for — we — early — at — park — an — started — the. 

To  —  asked  —  paper  —  my  —  have  —  teacher  — 
correct  —  the  —  I. 

A — defends — dog — good — his — bravely — master. 

Place  the  printed  words  before  the  child.  He  gives  the 
sentence  orally. 


224     THE  CONSERVATION  OF  THE  CHILD 

Time  limit  is  one  minute  for  each  sentence.  At  least 
two  must  be  given  correctly. 

Children  of  Twelve  Years. 

1.  Repetition  of  seven  figures: 

2,9,4,6,3,7,5.     1,6,9,5,8,4,7.     9,2,8,5,1,6,4. 
Tell  the  child  there  will  be  seven  figures.     Give  three 
trials.    One  success  is  suflScient. 

2.  Abstract  definitions : 

"What  is  charity?  Justice?  Goodness?"  Two  good 
definitions  must  be  given.  It  is  often  somewhat  difficult 
to  decide  if  the  definition  is  passable.  If  it  contains  the 
essential  idea  it  must  be  accepted,  however  badly  it  is 
expressed.  At  ten  years  a  third  succeed:  at  eleven  they 
are  generally  successful. 

3.  Repetition  of  a  sentence  of  26  syllables. 
(See  revision  for  new  sentence.) 

This  should  be  done  without  error. 

"Children,  it  is  necessary  to  work  very  hard  for  a  living. 
You  must  go  every  morning  to  your  school." 

24  syllables. 

"The  other  day  I  saw  in  the  street  a  pretty  young  dog. 
Little  Maurice  has  got  spots  on  his  apron." 

26  syllables. 

"Ernest  is  praised  very  often  for  his  good  conduct.  I 
bought  at  the  store  a  beautiful  doll  for  my  little  sister." 

28  syllables. 

"There  occurred  on  that  night  a  frightful  tempest  with 
lightning.  My  comrade  has  taken  cold.  He  has  a  fever  and 
coughs  very  much." 

30  syllables. 

4.  Resists  suggestion. 


CLASSIFYING  CLINIC  CASES  225 

5.  Problem  of  various  facts: 
"What  is  it?" 

(1)  "A  person  who  was  walking  in  the  forest  at  Fontaine- 
bleau  suddenly  stopped  imich  frightened  and  hastened  to  the 
nearest  police  and  reported  that  he  had  seen  hanging  from 
the  limb  of  a  tree  a "  (after  a  pause)  "what?" 

(2)  "  My  neighbor  has  been  having  strange  visitors.  He 
has  received  one  after  the  other  a  physician,  a  lawyer  and 
a  clergyman.  What  has  happened  at  the  house  of  my 
neighbor  ?" 

Both  questions  should  be  answered  correctly. 

The  answer  to  the  first  is  "a  dead  man."  Some  object 
to  this  story  as  too  gruesome.  Others  say  that  children 
are  not  so  sensitive  to  such  things  as  we  think.  Aside 
from  that  question  it  would  seem  that  the  picture  is 
hardly  familiar  enough  in  America  to  make  the  answer 
certain.    A  substitute  had  better  be  found. 

Children  of  Fifteen  Years. 

Adult. 

1.  Cutting  out: 

Get  the  child's  attention  and  let  him  see  you  fold  a 
sheet  of  paper  in  four.  Then  with  the  scissors  cut  a  small 
triangle  from  one  edge — the  edge  which  does  not  open. 
Ask  him  to  draw  a  picture  of  the  paper  as  it  \vill  look 
when  unfolded.  Do  not  unfold  or  allow  another  sheet  to 
be  unfolded.  It  is  a  difficult  test.  If  a  child  does  it  the 
first  time  always  ask  him  if  he  has  seen  it  before. 

2.  The  reversed  triangle : 

Cut  a  visiting  card  along  the  diagonal.  Ask  child  to 
describe  the  resulting  shape  if  one  of  the  triangles  was 
turned  about  and  placed  so  that  its  short  leg  was  on  the 

15 


226     THE  CONSERVATION  OF  THE  CHILD 

other  hypothenuse  and  its  right  angle  at  the  smaller  of 
tho  two  acute  angles. 

3.  Differences: 

Ask  the  difference  between 
Pleasure  and  happiness. 
Evolution  and  revolution. 
Event  and  advent. 
Poverty  and  misery. 
Pride  and  pretension. 

4.  Difference  between  President  of  a  Republic  and  a  King. 

5.  Give  sense  of  a  selection  read  to  him.'' 

A  Psycho-Physical  Analysis. — We  now  come  to  the 
last  stage  of  our  mental  diagnosis.  Heretofore  our  exami- 
nation has  been  concerned  chiefly  with  general  retardation 
and  our  efforts  have  been  definitely  directed  toward  deter- 
mining whether  the  retardation  so  discovered  was  perma- 
nent or  temporary.  If,  on  the  completion  of  the  examina- 
tions for  general  retardation,  the  psychologist  cannot 
fully  make  up  his  mind  concerning  the  subject,  and  also 
in  order  further  to  locate  the  precise  mental  aberration  in 
some  particular  process  of  consciousness  the  mental 
analysis  is  made. 

'  Revision  made  by  Henry  H.  Goddard,  Vineland,  N.  J.,  Training 
School 

For  other  systems  of  tests  see:  Whipple:  Manual  of  Mental  and 
Physical  Tests.     Warwick  and  York,  Inc.,  Baltimore,  Md.,  1910. 

Huey:  A  Syllabus  for  the  Clinical  Examination  of  Children. 
Warwick  &  York,  Baltimore,  Md.,  1911.  Warwick  &  York  also 
supply  record  blanks  for  Binet  tests  in  quantities  of  a  dozen  or 
more. 

Healy  and  Femald:  Tests  for  Practical  Mental  Classification. 
The  Psychological  Review  Co.,  Baltimore,  Md.,  1911. 

White,  Wm.  A.:  Outlines  of  Psychiatry,  New  York,  1911.  Contains 
much  on  methods  of  examination  and  tests. 

Report  of  Committee  on  Tests,  American  Psychological  Association, 
1910.    Psychological  Review  Pub.  Co.,  Baltimore,  Md. 


CLASSIFYING  CLINIC  CASES  227 

Manifestly  such  an  analysis  cannot  bo  treated  in  full 
in  this  place.  It  would  require  a  volume  in  itself.  But 
a  sketch  of  the  questions  and  the  tests  \vith  enough  descrip- 
tion to  enable  an  examiner  to  make  use  of  them  in  any 
clinic  is  appended.  From  this  it  will  be  seen  that  so  elab- 
orate and  complex  is  the  mental  analysis  that  for  exami- 
nation at  a  psychological  clinic  too  much  time  would  be 
required  for  every  case.  Its  purpose  as  noted  above  is  to 
decide  fully  upon  any  doubtful  case  or  to  locate  peculiar 
mental  disturbances.  It  is,  in  a  sense,  a  court  of  final 
appeal,  and  at  the  same  time  an  instrument  of  searching 
clinic  exactness  which  requires  for  its  application  an  experi- 
enced examiner  and  a  psychological  laboratory  equipped 
with  its  full  quota  of  scientific  apparatus. 

In  addition  to  this  the  mental  analysis  is  a  summation 
of  all  the  clinical  laboratory  tests  that  may  be  needed  to 
decide  the  condition  of  any  child.  The  tests  are  made  as 
full  as  possible  with  the  idea  not  that  they  shall  all  be 
used  in  regular  cases,  nor  possibly  any  of  them  used  in 
one  single  case,  but  rather  that  the  clinicist  may  have 
before  him  in  compendious  form  tests  necessary  for  detailed 
examinations  of  particular  mental  processes. 

REPORT  BLANK 
Mental  Examination  of Age.  . .  .Examined. . .  .by 


Part  1. — Sensation  and  Perception. 
1.  Visual: 


a.  Acuity 

b.  Heterophoria 

c.  Fields  of  Vision  and  of  Color  Vision. 

d.  Color  Vision 

e.  Visual  Perception  Span 


228     THE  CONSERVATION  OF  THE  CHILD 

2.  Auditory: 

a.  Acuity 

b.  Localization  of  Sound 

c.  Range  of  Sounds  Discernible 

d.  Auditory  Perception  Span 

3.  Tactile: 

a.  Acuity 

b.  Localization  of  Stimulus 

c.  Localization  of  Movement  of  Stimulus 

d.  Sensitivity  to  Tickling 

4.  Pressure: 

Acuity : 

L  Least  Discernible  Difference 

2.  Pain  Threshold 

5.  Thermal: 

Acuity : 

L  Least  Discernible  Difference 

2.  Pain  Threshold 

6.  KinoBsthetic: 

Acuity 

7.  Gustatory: 

Acuity 

8.  Olfactory: 

Acuity: 


Part  2. — Reproductive  Memory. 
Immediate  Memory  Span. 

a.  Articulate  Sound  Combinations 

b.  Visual  Symbols  for  Articulate  Sound  Combinations. 

c.  Color 

d.  Musical  Sound 

e.  Form 

Retentiveness. 


CLASSIFYING  CLINIC  CASES  229 


Part  3. — Apperception. 
Passive  Apperception  or  Association. 

a.  Train  of  Thought 

b.  Word  Association  Reactions 

c.  Emotional  Reactions 

1 .  Superficial 

2.  Physiological  Changes  Accompanying  Emotional  States 

Active  Perception. 

a.  Sustained  Attention  to  Intellectual  Work 

b.  Voluntary  Attention 

c.  Attention  to  Disparate  Activities 

d.  Discriminative  Attention 

e.  Active  Imagination. 

1 .  Linguistic 

2.  Invention 

f .  Reason 


Part  4. — Volitional  Motor  Ability. 

1.  Control  of  Muscles  while  in  fixed  position: 

a.  Body 

b.  Hand  and  Arm 

2.  Accuracy  of  Movement 

3.  Steadiness  of  Movement 

4.  Speed  of  Movement 

5.  Fatigue — Muscular 

6.  Reaction  Time 

a.  Simple  Reactions 

1.  Light 

2.  Sound 

3.  Touch 

4.  Electricity 

b.  Compound  Reactions 

1.  Discrimination 

2.  Choice 

3.  Cognition 


230     THE  CONSERVATION  OF  THE  CHILD 


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CLASSIFYING  CLINIC  CASES 


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234     THE  CONSERVATION  OF  THE  CHILD 


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240     THE  CONSERVATION  OF  THE  CHILD 


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CLASSIFYING  CLINIC  CASES  241 


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242     THE  CONSERVATION  OF  THE  CHILD 


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CLASSIFYING  CLINIC  CASES 


243 


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244     THE  CONSERVATION  OF  THE  CHILD 


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1  lu'  rci'unl  made  by  tlu>  plcthysiiio^iraph  ami  tiif  piicuinofirai)!!  ou 
a  roll  ot"  smoked  paper. 


CLASSIFYING  CLINIC  CASES 


245 


246     THE  CONSERVATION  OF  THE  CHILD 


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'riic  plctliysinofiiaph.  for  rcconliuii  fiiio  variations  in  emotions, 
is  tlic  cylindrical  api)aratus  with  its  several  rubber  tubes.  The 
Ijneuniofiraph  is  the  a])parafus  strapped  to  the  boy's  chest  and 
.records  variations  in  l)reatliin'i;. 


CLASSIFYING  CLINIC  CASES  247 


c  if  i  P  o 


g^e'"  ?  o  =*  2.22       sbc  g  "^  c=3  °  «  Is  =3       S  3   .0  T  5-.5P  c:  b'S  ^  c 
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248     THE  CONSERVATION  OF  THE  CHILD 


IB  •—  ^ 


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240 


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VIII. 
MORAL  DEVIATES 

No  cases  presented  at  the  Psychological  Clinic  are  so 
difficult  to  classify  as  those  brought  on  account  of  bad 
conduct.  The  whole  problem  of  moral  delinquency  and 
incorrigibility  is  plunged  into  the  deepest  confusion,  not 
only  on  account  of  its  own  inherent  difficulties,  but  also 
on  account  of  related  problems  concerning  morality, 
moral  responsibility,  the  soul,  the  nature  of  sin,  crime, 
evil  and  the  punitive  or  preventive  measures  to  be  adopted 
toward  the  transgressor.  All  of  these  questions,  though 
perhaps  not  directly  related  to  the  problem  of  classifying 
bad  boys  and  girls,  nevertheless  thrust  themselves  with  the 
proverbial  impudence  of  immorality  upon  the  clinicist's 
attention.  The  traditions  of  society,  the  organization  of 
penal  and  reformatory  institutions  and  the  prejudices  of 
guardians,  teachers,  and  moral  reformers,  compel  him  to 
take  cognizance  of  them.  If  he  is  wise,  he  will  at  the 
very  beginning,  as  far  as  possible,  clear  away  the  mass  of 
irrelevant  and  confusing  material  surrounding  this  task 
and  fix  upon  some  clear  and  practical  fundamental  notion 
for  his  guidance.  He  may  begin  by  formulating  two 
salient  questions:  What  is  moral  imbecility?  How  shall 
it  be  diagnosed? 

What  Writers  Say  of  Moral  Imbecility. — To  answer 
the  first  question,  and  thereby  secure  some  basis  for  reply- 
ing to  the  second,  the  clinicist  must  turn  to  a  study  of 
what  writers  have  said  upon  the  subject  and  especially 
upon  the  possibility  of  finding  moral  imbecility  in  minds 
otherwise  sound. 

950 


MORAL  DEVIATES  251 

Pinel,  according  to  Pilchard,  was  the  first  to  propose 
the  theory  that  some  persons  seem  morally  Irresponsible 
though  intellectually  capal)le.  "I  have  already  had  occa- 
sion to  observe  that  the  existence  of  moral  insanity  as  a 
distinct  form  of  derangement   has  been  recognized   by 

Pinel Pinel    terms    this    affection    '  emportement 

maniaque  sans  delire.'  "  ^  "These  are  mad  men,"  the  latter 
writes:  "in  whom  there  is  no  perceptible  alteration 
of  the  intellectual  process,  of  the  perception,  judging 
faculties,  imagination  or  memory,  and  yet  a  perversion 
of  the  manifestations  of  the  will  in  a  blind  impulse  to  the 
commission  of  violence  or  even  bloodthirsty  rage,  ^vithout 
any  assignable  dominant  idea  in  delusion  of  the  imagina- 
tion which  would  cause  such  propensity." 

Dr.  Benjamin  Rush,-  wTiting  in  1830,  and  also  referring 
to  his  own  lecture  of  1810,  apparently  agrees  with  Pinel, 
as  he  mentions  a  disease  called  "  moral  derange- 

KUSD 

ment,"  which  discovers  itself  only  m  the  moral 
faculty,  and  exists  with  a  sound  state  of  the  conscience 
and  sense  of  duty."    He  believes  that  "the  will  is  diseased 
and  acts  reflexly  or  convulsively." 

Prichard,^  ^vriting  in  1835,  believed  that  a  defective 
moral  sense  was  sometimes  co-existent  ^\^th  a  perfectly 
normal  intellect,  and  first  used  the  term  moral       „    ,,    , 

'  .  Pnchard 

insanity  which  included  both  impulsive  insanity 
and  moral  insanity  and  imbecility,  the  former  being  applied 
to  those  cases  of  exceptional  acts  of  irrational  violence, 
the  latter  to  those  cases  characterized  by  habitual  and 

^  Pinel,  Traite  Medico-Philosophique  sur  I'alienation  mentale 
2  me.  edit.  Paris,  1809,  p.  156.  Quoted  by  James  C.  Prichard  in 
Treatise  on  Insanity,  1S35,  pp.  4,  14. 

^  Benjamin  Rush,  Medical  Iiujuiries  and  Ob.servations  upon  the 
Diseases  of  the  Mind,  1830,  pp.  201,  202. 

» James  C.  Prichard,  Treatise  on  Insanity. 


252     THE  CONSERVATION  OF  THE  CHILD 

unresisted  selfish,  sensual,  and  egotistic  acts.  This  dis- 
tinction between  the  exceptional  and  the  habitual  is 
significant,  but,  as  we  shall  see  later,  it  is  not  sufficient 
to  differentiate  the  true  moral  imbecile  from  a  persistent 
yet  corrigible  sinner. 

His  remarks,  for  their  historical  richness,  are  worth 
quoting  fully,  but  we  cannot  do  more  than  give  the  follow- 
ing summary. 

Of  the  symptoms  he  says : 

"The  modifications  of  insanity  already  mentioned  are 
affections  of  the  understanding  or  rational  powers,  but 
there  is  likewise  a  form  of  mental  derangement  in  which 
the  intellectual  faculties  appear  to  have  sustained  little 
or  no  injury,  while  the  disorder  is  manifested  principallj'^ 
or  alone,  in  the  state  of  the  feelings,  temper,  or  habits." 

Then  he  adds  his  definition  of  moral  insanity  as  follows: 

"Moral  insanity,  or  madness  consisting  in  a  morbid 
perversion  of  the  natural  feelings,  affections,  inclinations, 
temper,  habits,  moral  dispositions  and  natural  impulses, 
without  any  remarkable  disorder  or  defect  of  the  intellect 
or  knowing  and  reasoning  faculties,  and  particularly  with- 
out any  insane  illusion  or  hallucination." 

Seguin,^  the  pioneer  and  apostle  of  education  for  mental 
defectives,  curiously  enough  says  nothing  specifically,  in 
his  publication  of  1866,  about  moral  imbeciles, 
though  he  clearly  indicates  his  belief  in  a  moral 
nature  among  idiots,  and  leans  to  the  opinion  that  their 
cruelty  and  viciousness  are  frequently  due  to  bad  environ- 
ment or  bad  training.  A  few  quotations  will  show  his 
view: — 

*  Edw.  Seguin,  Idiocy,  1866,  pp.  64,  65. 


MORAL  DEVIATES  253 

"That  the  idiot  is  ondowed  with  a  moral  nature,  no 
one  who  has  had  the  happiness  of  ministering  to  him  will 
deny.  Epileptic,  paralytic,  choreic,  or  imbecilic  children 
will  often  strike  or  bite  their  mother  or  affectionate  at- 
tendant. If  any  idiot  is  found  doing  the  same  (and  we 
never  find  any)  he  must  have  been  taught  it  by  some 
cruel  treatment  imposed  upon  him.  In  genf^ral,  as  soon 
as  his  mind  is  open  to  reflection,  the  tender  family  feelings 
arc  so  deep  in  him  that  they  often  interfere  ^vith  his 
successful  transplantation  into  the  broader  and  richer 
ground  of  our  public  institutions.  It  is  true  that  his  habits 
are  sad,  droll,  or  repulsive,  that  his  doings  are  often 
worse  than  none;  but  these  manifestations  exhibit  as 
much  the  carelessness  and  want  of  intelligence  of  the 
parents  or  keepers  as  they  do  the  primary  character  of 
the  infirmity. 

"As  a  collective  body,  idiot  children  are,  in  their  insti- 
tutions, equal  in  order  and  decency,  in  true  lovingness, 
if  not  in  loveliness,  to  any  collection  of  children  in  the 
land.  Their  normal  powers  are  influenced  by  isolation, 
company,  multitude,  silence,  turmoil,  music,  human 
eloquence,  as  they  are  in  all  masses  of  mankind.  If  we 
are  asked  how  we  pretend  to  see  all  these  good  and  promis- 
ing dispositions  in  the  unfortunate  subject  whom  we  have 
depicted  as  more  or  less  motionless,  speechless,  and  repul- 
sive, we  can  affirm  that  the  idiot,  even  when  neglected 
in  his  lowest  conditions,  does  not  manifest  any  character 
contrary  to  the  one  here  described;  a  character  which  we 
have  seen  him  assume  steadily  and  uniformly,  under  the 
influence  of  proper  training,  and,  as  we  firmly  believe,  in 
virtue  of  his  o\vn  moral  nature :  he  is  one  of  us  in  mankind, 
but  shut  up  in  an  imperfect  envelope." 


254     THE  CONSERVATION  OF  THE  CHILD 

Maudsley/^  in  his  works  of  1868,  1871,  1876  makes 
moral  insanity  an  independent  mental  disease, 
describes  its  symptoms,  and  refers  it  back 
chiefly  to  heredity. 

Under  the  head  of  affective  insanities  of  early  life,  he 
speaks  of  moral  insanity  and  moral  imbecility.  The 
cases  described  as  illustrative  of  both  classes  are  quite 
similar,  differing  chiefly  in  that  the  moral  insanity  is  a 
temporary  state,  while  moral  imbecility  is  a  permanent 
one.  Moral  imbeciles,  he  says  are  instinctive  liars  and 
thieves;  they  are  entirely  lacking  in  all  natural  affection 
and  their  one  impulse  is  self-indulgence.  For  selfish  grati- 
fication they  will  resort  to  all  sorts  of  cunning,  which 
indicates  good  mental  power. 

"The  eminent  men,"  he  says  in  another  place,  "who 
have  studied  insanity,  and  whose  authority  we  habitually 
accept,  are  entirely  agreed  as  to  the  existence  of  a  form  of 
mental  disorder  in  which,  without  any  hallucination, 
illusion,  or  delusion,  the  symptoms  are  exhibited  in  a 
perverted  state  of  those  mental  faculties  usually  called  the 
active  and  moral  powers  or  included  under  feeling  and 
volition — the  feelings,  affections,  propensities,  temper, 
habits,  and  conduct.  .  .  .  When  moral  insanity  is 
thought  to  exist  by  itself,  and  to  constitute  the  disease, 
as  it  certainly  may  do,  it  would  be  quite  unjustifiable  to 
assume  that  a  particular  vicious  act  or  crime,  or  a  series  of 
vicious  acts,  proved  its  existence;  in  the  previous  history 
of  the  patient  there  will  be  evidence  of  a  sufficient  cause  of 
disease  having  been  followed  by  an  entire  change  of  man- 
ner, of  feeling,  and  acting.  The  vicious  act  or  crime  will 
be  logically  traceable  through  a  chain  of  symptoms  to 

^  The  Physiology  and  Pathology  of  the  Mind.  Henry  Maudsley. 
2nd  Ed.  1868,  pp  356-365;  1871,  pp.  311,  312. 


MORAL  DEVIATES  «55 

disease  as  cause,  as  the  acts  of  the  sane  man  are  traced  or 
deduced  from  his  desires  and  motives.  'There  is  often,' 
says  Dr.  Prichard,  who  first  called  attention  to  this  form 
of  mental  derangement,  'a  strong  hereditary  tendency  to 
insanity.' " 

D.  Hack  Tuke,^  in  his  "Dictionary  of  Psychological 
Medicine,"  published  in  1892,  begins  his  article  on  Moral 
Insanity  with  Prichard's  definition  and  sums  it 
up  with  a  few  statements  to  which  he  attaches  a 
brief  bibliography.  He  agrees  very  decidedly  with  the 
theory  of  moral  deficiency  without  intellectual  impair- 
ment, and  suggests  the  difficulty  of  diagnosis  in  these 
words : 

"Each  case  must  be  decided  in  relation  to  the  individ- 
ual himself,  his  antecedents,  education,  surroundings,  and 
social  status,  the  nature  of  certain  acts,  and  the  mode  in 
which  they  are  performed,  along  with  other  circumstances 
fairly  raising  the  suspicion  that  they  are  not  under  his 
control." 

Dr.  Kerlin,'^  however,  was  the  first  to  classify  moral 
imbeciles  as  a  distinct  type,  a  type  that  he  included  with 
those  who  displayed  grave  moral  defects,  whether 

•   ,        ,  ,      ,    P  .  Berlin 

associated  with  the  mental  defect  or  not,  but 

adds  that  moral  imbecility  is  often  associated  with  mental 

defect.    His  biographer  says: 

"He  was  among  the  first  to  recognize  the  existence  of 
the  class  .  .  .  the  members  of  which  are  not  responsible 
for  their  birth  or  inheritance,  though  often  of  more  than 
precocious  intellect.  .  .  .  He  first  mentioned  them  in 
his  report  to  the  managers  in  1884.    In  his  report  of  1889, 

•  D.  Hack  Tuke,  A  Dictionary  of  Psychological  Medicine,  1892. 
^  Forty-first  Annual  Report  of  the  Pennsylvania  Training  School 
for  Feeble-minded  Children,  Phila.,  1893,  pp.  49,  50. 


256     THE  CONSERVATION  OF  THE  CHILD 

Dr.  Kerlin  says  that  at  last  these  unfortunates,  moral 
imbeciles,  seem  to  have  come  under  easier  recognition 
than  formerly.     .     .     .     He  says: 

"  'To  those  who  have  any  doubt  of  the  existence  of  a 
distinct  class,  the  discussion  of  the  recent  International 
Congress  of  Criminal  Anthropology  in  Paris  would  be  a 
revelation,  and  a  practical  acquaintance  with  the  inmates 
of  the  institution  a  conversion,' " 

His  classification  will  be  given  later,  in  connection  with 
Barr's  consideration  of  this  subject, 

Shuttleworth  ^  agrees  with  Kerlin  in  stating  that  a  slight 
intellectual  deficiency  sometimes  accompanies  moral 
Shuttle-  imbecility  and  adds  that  the  intellectual  capaci- 
^°^^^  ties  of  such  individuals  may  improve  while  their 

moral  condition  deteriorates.    He  believes  that: 

"Perhaps  the  most  trying  cases  we  are  called  on  to  deal 
with  among  children  mentally  abnormal — there  is  in  this 
instance  often  but  little  intellectual  deficiency — is  that  of 
the  moral  imbecile.  ...  He  (or  she)  may  combine 
the  most  innocent,  sometimes  engaging,  external  appear- 
ances with  an  inner  depth  of  cunning  and  iniquity  which 
requires  to  be  experienced  to  be  appreciated.  The  sudden 
impulses  to  mischief  occurring  in  these  cases  are  probably 
of  an  epileptoid  character,  and  paroxysms  may  sometimes 
be  cut  short  by  bromides.  But  as  a  rule  moral  discipline 
is  of  little  avail;  punishment  may  be  administered,  and 
professions  of  penitence  called  forth,  only  to  be  forgotten 
as  soon  as  the  mental  disturbance  again  recurs.  The 
author  has  a  vivid  recollection  of  three  nice-looking  chil- 
dren, sisters  and  brother,  formerly  under  his  care,  who  at 
times  would  appear  models  of  propriety,  while  at  others 

8  Shuttleworth,  G.  E.,  Mentally  Deficient  Children,  London, 
1900,  pp.  126  ff. 


MORAL  DEVIA  PES  257 

they  had  all  the  characteristics  of  little  demons.  With 
innocent  expressions  they  would  furtively  accomplish  the 
most  abominable  mischief,  and  after  meekly  acknowledg- 
ing the  error  of  their  ways  would  emphasize  their  apology 
by  a  missile  flung  at  the  head  of  the  person  who  had 
attempted  to  bring  them  to  repentance.  Such  children 
would  in  olden  times  have  been  called  'possessed';  now 
they  are  classified  as  cases  of  moral  imbecility  or  juvenile 
insanity.  Dr.  Samuel  J.  Foet'  has  described  similar  cases 
under  the  title  of  'Psychical  Epilepsy.'" 

Kellogg  ^^  defines  moral  degeneracy  both  etiologically 
and  symptomatologically,  and  connects  it  usually  with 
inheritance.     He  calls  it:  "A  distinct  form  of 

...  ...  Kellogg 

mental  disease,  arismg  from  a  constitutional 
neuropathic  state  ordinarily  inherited,  though  exception- 
ally acquired,  and  characterized  by  deficiency  of  moral 
understanding  or  perversion  of  the  emotional  nature 
by  brutal  instinctive  tendencies,  and  by  shameful  conduct 
unrestrained  by  any  sense  of  right  or  wrong,  or  by  any 
self-respect  or  fears  for  others." 

The  symptoms  of  this  neuropathic  state  are  emotional 
perversion,  vanity,  selfishness,  absence  of  altruistic  feel- 
ings, like  pity,  sympathy,  and  natural  affection,  and  a 
volition  too  weak  to  withstand  the  fierce  impulses  of 
animal  passions. 

William  H.  Ireland  ^^  is  of  the  opinion  that  moral  imbe- 
cility is   always  accompanied   by  some   slight 
abnormality  of  intellect,  although  such  defect 
may  seem  out  of  all  proportion  to  the  moral  degeneracy. 

'  Proc.  Association  Anier.  Institution  for  Idiotic  and  Feeble- 
minded Persons,  1894,  p.  400. 

'0  Kellogg's  Text  Book  of  Mental  Diseases,  1897,  pp.  555  to  500. 

"  Wm.  H.  Ireland,  Mental  Affections  of  Children,  1900,  pp.  287, 
288. 

17 


258     THE  CONSERVATION  OF  THE  CHILD 

Berkley  ^^  states  that  imbecility  may  be  shown  by  moral 
obloquy  not  necessarily  accompanied  by  other  signs  of 
weak-mindedness.  He  recognizes  two  types  of 
the  high-grade  imbecile:  the  one  verj'-  deficient 
mentally,  and  the  other  with  one-sided  but  active  mental 
development.  This  latter  class  is  as  a  whole  defective 
morally.  They  possess  a  low  cunning  and  propensity  for 
every  kind  of  crime,  coupled  with  a  facility  in  language 
and  a  sharpness  of  apprehension. 

Dr.  Tredgold^^  believes,  "There  may  be  one  class  of 
persons  who  are  so  constituted  that  they  are  utterly 
_    ,    , ,      devoid  of  any  real  moral  sense,  and  of  the  con- 

Tredgold  .  "^  ... 

sciousness  that  any  obligation  is  morally  due 
from  them  to  their  fellows;  just  as  others  may  have  no 
sense  of  religion  or  no  conception  of  the  beauties  of  form, 
color  or  sound.  Such  defect  is  inherent,  and  it  may 
rightly  be  called  moral  deficiency. 

"  Its  relation  to  criminality,  however,  is  another  matter. 
It  may  be  that,  although  these  persons  have  no  feelings  of 
repugnance  or  shame  at  the  thought  of  a  criminal  or 
inunoral  act,  and  although  they  cannot  appreciate  the 
ethics  of  the  Decalogue,  nevertheless,  their  intelligence 
tells  them  that  certain  unpleasant  consequences,  in  the 
shape  of  judicial  punishment  or  social  censure,  will  follow 
transgression,  and  this  suffices  to  keep  them  within  the 
prescribed  legal  and  social  code.  Their  moral  defect  is, 
in  fact,  latent.  .  .  .  But  although  latent  moral  defec- 
tives of  this  kind  are  not  of  necessity  actual  criminals, 
they  may  well  be  described  as  potential  criminals.  .    .    . 

"  But  the  case  is  different  with  another  class.    There  are 

'2  Berkley,  Henry  J.,  Mental  Diseases.  New  York,  D.  Appleton 
and  Co.,  1900. 

"  A.  F.  Tredgold,  Mental  Deficiency,  London,  1908,  pp.  76  ff. 


MORAL  DEVIATES  259 

some  persons,  likewise  deficient  in  moral  sense,  who 
repeatedly  commit  criminal  acts,  and  upon  whom  punish- 
ment has  not  the  slightest  deterrent  effect  whatever. 
These  form  a  large  proportion  of  the  instinctive  or  habit- 
ual criminal  class,  the  true  moral  defectives,  and  they 
may  be  defined  as  'those  persons  who  display  from  an 
early  age,  and  in  spite  of  careful  upbringing,  strong  vicious 
or  criminal  propensities  on  which  punishment  has  little 
or  no  effect.'" 

Tredgold's  definition  is  essentially  that  of  the  Royal 
Commission,  reported  as  follows:  "  The  moral  imbecile  is 
a  person  who  by  reason  of  arrested  development  or  disease 
of  the  brain  dating  from  birth  or  early  years  displays  at 
an  early  age  vicious  or  criminal  propensities  which  are  of 
an  incorrigible  or  unusual  nature,  and  are  generally  asso- 
ciated with  some  slight  limitation  of  intellect."^* 

Then  the  Commission  adds  a  very  valuable  distinction 
between  moral  imbecility  and  moral  insanity  in  these 
words:  "Of  another  class  also — the  morally  insane — 
definitions  were  suggested  to  us.  The  definition  of  the 
Royal  College  of  Physicians  was  as  follows:  'Morally 
insane  person  means  a  person  who,  after  many  years  of 
reputable  life,  all  at  once  unaccountably  exhibits  vicious 
propensities,  or  takes  to  criminal  courses.'  Sir  James 
Crichton-Bro\vne's  definition  is — 'A  morally  insane  per- 
son is  one  who  by  reason  of  disease  or  disorder  of  the 
brain  has  undergone  a  change  of  character  manifested  in 
a  course  of  vicious  or  criminal  conduct  without  obvious 
impairment  of  intellect.'  These  definitions  connect  them- 
selves not  with  the  retardation  of  the  brain  which  mani- 
fests itself  at  birth  or  in  the  twelve  years  of  life,  but  with 

"  Report  of  the  Royal  Ckjmmission  on  the  Care  and  Control  of 
the  Feeble-minded,  vol.  viii,  1908,  p.  189. 


260     THE  CONSERVATION  OF  THE  CHILD 

disorder  of  the  mind  at  a  later  date,  or  'acquired.'  The 
morally  insane  are  thus  included  in  the  definition  of 
'  Persons  of  Unsound  Mind '  in  Recommendation  IV.  And 
we  do  not  consider  it  scientifically  correct  to  constitute 
them  into  a  separate  category."^^ 

A  Summary  of  the  Opinions  on  Moral  Imbecility. — 
This  short  historical  sketch  serves  to  illustrate  the  con- 
fusion spoken  of  in  the  first  part  of  this  chapter.  The 
tendency  of  writers  is  clearlj'^  toward  belief  in  moral  defi- 
ciency as  a  distinct  disease  of  human  character,  though  the 
symptom-complex  and  the  etiology  are  more  or  less  vaguely 
defined.  Undoubtedly  some  of  the  earlier  writers  were 
misled  in  their  treatment  of  the  subject  by  traditional 
views  of  morality  which  led  them  into  comparatively 
unimportant  attempts  to  prove  the  existence  of  moral 
imbecility.  The  result  of  their  efforts  is  valuable  to  the 
clinicist  chiefly  in  proving  to  him  the  futility  of  looking 
for  a  peculiar  symptom-complex,  by  which  he  may 
diagnose  a  case.  To  show  what  he  should  look  for,  he 
must  begin  by  laying  aside  preconceived  opinions  of 
morality  and  making  a  brief  and  simple  analysis  of 
moral  standards. 

Three  Systems  of  Morality. — What  constitutes  moral- 
ity? is  a  question  subsidiary  but  necessary  to  our  main 
inquiry,  and  it  may  be  at  once  aSirmed  that  to  it  no  abso- 
lute, imiversal  valid  answer  can  be  given.  In  his  "  Method 
of  Ethics,"  Professor  Henry  Sidgwick  shows  by  a  study  of 
common  sense  or  popular  opinion  that  no  single  and 
simple  method  of  determining  right  and  wrong  is  in  use, 
but  that  many  methods  of  ethics  are  put  forward  as 
equally  universal  and  equally  valid.     All  of  these  he  be- 

i»  Report  of  the  Royal  Commission  on  the  Care  and  Control  of 
the  Feeble-minded,  vol.  viii,  1908,  p.  190. 


MORAL  DEVIATES  261 

lieves  can  be  reduced  to  three  systems.  The  first  he  calls 
"Egoistic  Hedonism"  and  its  fundiimontal  prinr-iple  is, 
"Let  each  one  seek  his  own  greatest  liappiness,"  or,  to  be 
more  accurate,  "  The  greatest  surplus  of  pleasure  over 
pain."  The  second  he  calls  "Universal  Hedonism,"  or 
"Utilitarianism,"  the  fundamental  principle  of  which  is, 
"Let  each  one  seek  the  greatest  happiness  of  the  greatest 
number."  The  third  system,  called  "Intuitionism,"  is 
the  traditional  morality,  or  morality  in  its  narrow  sense, 
the  only  kind  considered  by  many  as  morality  at  all.  Its 
fundamental  principle  is:  "Do  right  for  right's  sake,"  and 
the  rightness  or  wrongness  of  any  act  is  believed  to  be 
immediately  or  intuitively  perceived  by  the  "moral 
sense." 

This  moral  sense,  in  germ  at  least,  is  innate.  It  is  poten- 
tially there  at  birth.  At  some  particular  time  in  the  life 
of  an  individual  it  develops.    Then  the  person,  ,,     ,„ 

Moral  Sense 

according  to  popular  opinion,  becomes  morally 
responsible;  that  is,  this  moral  sense,  either  intuitively 
and  immediately  in  any  particular  case,  or  immediately 
from  moral  principles  intuitively  known,  instructs  the 
person  in  what  is  right  and  what  is  wrong.  Along  with 
the  moral  sense  conscience  develops.  It  is  an  impulse  in 
consciousness  urging  one  toward  what  his  moral  sense 
tells  him  is  right  and  away  from  what  it  tells  him  is  wrong, 
and  rewarding  him  with  a  warm  glow  of  approbation  for 
duty  well  done,  or  pursuing  him  with  remorseful  pangs 
for  transgressions  committed. 

With  this  brief  analysis  before  us  we  are  now  in  a  better 
position  to  define  our  standards  of  true  morality  and  hence 
of  moral  imbecility.  Our  next  step  is  to  reduce  the  three 
foregoing  methods  or  systems  of  ethics  to  psychological 
terms. 


262     THE  CONSERVATION  OF  THE  CHILD 

Two  Psychological  Systems  of  Morality. — The  first 
two  systems  obviously  depend  upon  purposes  or  ends  for 
the  determination  of  right  or  wrong  If  an  egoist  is  con- 
fronted with  two  alternatives  he  must  determine  which 
one  will  lead  him  to  the  greater  happiness.  He  must 
reflect,  judge,  reason.  Likewise  the  utilitarian  must 
choose  his  means  to  his  end.  The  difference  between 
the  two  systems  resides  in  both  the  motives  and  the  ends. 
The  egoist's  motive  is  self-love,  and  his  aim  self-pleasure; 
the  utilitarian's  motive  is  love  for  mankind  and  his  aim 
their  happiness.  Both  systems — to  whatever  they  may 
be  reducible  in  an  ultimate  analysis — involve  a  cer- 
tain amount  of  reasoning  and  are  therefore  called 
rational  systems  of  ethics.  A  person  bereft  of  reason- 
ing powers  could  never  be  guided  by  either  method  in 
his  knowledge  of  right  or  wrong  or  in  his  choice  of  good 
or  bad  conduct. 

The  third  system  differs  both  ethically  and  psycho- 
logically from  the  other  two.  The  moral  sense  upon 
which  it  depends  for  clear  and  valid  enunciations  of  right 
and  wrong  is  by  its  nature  a  feeling  of  certainty.  The 
conscience  through  which  the  immediate  edicts  of  this 
moral  sense  are  rendered  operative  in  conduct  is  by  its 
nature  and  development  an  instinct  or  a  group  of  instincts, 
one  of  the  many  with  which  man  is  richly  endowed.  The 
intuitive  system,  therefore,  can  be  called  instinctive. 

Thus  all  morality  may  be  said  to  be  rational  or  instinc- 
tive. This  statement,  be  it  remembered,  must  be  taken 
with  our  practical  task  of  diagnosis  in  view.  Not  for  a 
moment  is  it  urged  that  such  a  brief  analysis  is  satisfac- 
tory for  settling  all  moral  problems.  It  is  made  solely  and 
simply  to  give  the  practical  clinician  a  clearer  view  of  his 
problem,  to  let  him  know  in  some  measure  what  he  faces 


MORAL  DEVIATES  263 

when  he  must  diagnose  a  case  of  moral  imVjecility.  For 
this  purpose  the  conchisions,  it  is  hoped,  are  sound  and 
valid. 

Possible  Varieties  of  Moral  Imbecility. — From  our 
ethical  and  psychological  analyses  wc  have  arrived  at 
the  following  results.  Moral  iml)ecility  is  a  term  that 
depends  for  its  content  upon  the  point  of  view  of  the 
speaker.  His  ethical  theory  determines  for  him  the 
meaning  of  moral  imbecility.  The  intuitionist  insists  that 
a  normal  moral  being  shall  possess  a  moral  sense  and  a 
conscience.  Any  one  who  is  deficient  in  these  respects  is, 
by  his  definition,  a  moral  imbecile. 

From  the  egoist's  point  of  view  the  matter  may  be 
entirely  different.  For  him  an  individual  with  no  moral 
sense  may  still  be  morally  normal.  If  he  were  able,  with- 
out a  moral  sense,  by  reasoning  alone  to  elect  the  proper 
means  to  his  o^vn  best  self-satisfaction,  he  would  be  moral. 
He  would  believe,  however,  that  if  a  person  had  no  self- 
regarding  impulses  whatsoever  or  w'as  distinctly  deficient 
in  that  respect,  he  would  of  necessity  be  a  moral  imbecile. 
If,  further,  he  did  possess  normal  self-regarding  impulses 
but  had  not  sufficient  reason  to  choose  means  to  his  own 
happiness,  he  would  be  morally  imbecilic. 

Between  the  intuitive  and  the  egoistic  views  paradoxical 
situations  might  arise.  An  individual  could  very  well 
exist  who,  in  the  intuitive  sense  noted  above,  might  be  a 
bom  moral  imbecile  and  yet  develop  into  a  moral  man. 
Though  he  could  never  decide  intuitively  upon  the  right- 
ness  or  wrongness  of  any  particular  act,  and  so  would 
technically  be  a  moral  imbecile,  yet  he  might  not  be  a  bad 
fellow  at  all.  He  might  have  intelligence  enough  to  learn 
how  to  attain  his  o\mi  ends  in  his  social  group  without  any 
offence  to  his  neighbors.     His  whole  scheme  of  conduct 


264     THE  CONSERVATION  OF  THE  CHILD 

would  be  based  upon  intelligent  self-interest,  perfectly- 
moral  to  an  egoist  and  perfectly  non-moral  to  an  intui- 
tionist.  He  might,  of  course,  be  a  hard  subject  to  guide 
into  virtuous  paths,  but  in  the  end  he  might  be  developed 
into  a  more  consistent  life  than  his  so-called  normal 
brother,  born  happily  with  the  usual  moral  sense,  and 
trained  with  the  usual  poor  methods. 

The  matter  changes  once  more  with  the  utilitarian. 
The  moral  imbecile  would  now  be  one  who  is  deficient  in 
other-regarding  impulses.  Love,  sympathy,  benevolence, 
and  the  social  instincts  in  general,  might  be  remote  from 
his  comprehension.  Lacking  these  fundamental  human 
attributes  he  could  not  make  a  perfect  utilitarian.  Yet 
he  might  possess  docility  enough  to  learn  how  to  cover  his 
deficiencies  by  discovering  what  other  people  wanted  and 
reason  enough  to  choose  the  right  means  to  supply  them. 

For  instance,  he  might  lack  sympathy,  and  so  never  be 
able  to  put  himself  in  the  place  of  any  one  else,  to  feel  the 
^, ...     .       sympathetic  vibration  of  his  own  soul  at  the 

utilitarian         .  . 

Moral  Sight  of  Suffering  of  others,  to  weep  with  those 

Imbecile  ~^  . 

who  weep,  or  laugh  with  those  who  laugh.  If, 
however,  he  has  mentality  enough,  and  could  learn  in  a 
cold,  calculating  way  what  emotions  to  simulate,  what  ac- 
tions to  avoid,  and  what  to  perform,  in  order  to  fit  into  his 
group  of  society,  although  he  would  be  decidedly  lacking 
in  what  would  be  the  usual  moral  equipment  of  a  normal 
individual,  yet  by  society  he  would  not  be  counted  a 
moral  imbecile,  because  he  possessed  mentality  enough  to 
learn  to  simulate  moral  acts.  For  after  all,  under  certain 
conditions,  society  is  extremely  lenient  toward  the  motives 
of  its  members,  though  many  casuists,  no  doubt,  would 
insist  that  such  a  calculating  machine  could  not,  for  one 
moment,  be  called  a  moral  being.     Yet  even  to  them  it 


MORAL  DEVIATES  265 

might  be  argued  with  some  show  of  truth  that  such  a 
painstaking  imitation  of  virtuous  conduct  dosorved  greater 
merit  tluin  the  natural,  spontaneously  growing  variety. 

On  the  other  hand,  lack  of  intelligence  need  not  produce 
a  utilitarian  moral  imbecile.  A  man  lacking  a  moral  sense, 
and  without  full  reasoning  powers,  might  be  so  liberally 
endowed  with  social  instincts  and  so  free  from  selfish  or 
destructive  impulses  that  his  conduct  would  be  always  in 
sympathetic  accord  with  his  fellows,  or  at  any  rate,  because 
of  the  impotence  of  his  egoistic  impulses,  not  in  discord 
with  them.  Such  a  person  would  make  a  perfectly  agree- 
able, though  rather  stupid,  member  of  society.  Far  from 
being  accounted  a  moral  degenerate,  he  would  most  prob- 
ably live  and  die  with  a  reputation  for  remarkable  good- 
ness. Every  psychiatrist  is  acquainted  with  such  a  moral 
creature, — spineless,  passive,  amiable,  safe  from  evil  as 
long  as  they  are  well  sheltered  in  irmocent  surrounduigs. 

Still  one  more  point  of  view  remains.  That  is  the  way  in 
which  society  at  large  looks  upon  the  matter.  Here  the 
motives  of  conduct  fall  somewhat  into  the  background. 
The  emphasis  at  least  is  upon  social  or  anti-  ^^^.^^ 

social  acts.     If  the  conduct  is  of  long  duration  Point 

"  of  View 

and  special  perversity,  society  begins  to  suspect 
that  something  is  wrong  with  the  mentality  of  such  an  indi- 
vidual, may  engage  in  more  or  less  speculative  concern 
about  it  and  so  bring  the  moral  judgment  of  the  commun- 
ity to  bear  upon  the  man's  motives.  But  on  the  whole  the 
incident  of  supreme  importance  is  what  he  does,  not  what 
he  feels  or  what  he  thinks.  As  long  as  his  actions  do  not 
cause  social  disturbances  of  certain  degrees  or  kinds,  they 
arc  passed  over  as  not  of  sufficient  importance  to  demand 
any  serious  attention.  Generally  speaking,  the  point  of 
view  of  society  as  a  whole  is  a  strange  mixture  of  the  three 


266     THE  CONSERVATION  OF  THE  CHILD 

ethical  methods  noted  above,  with  legalistic  opinions  and 
criminal  codes  th^o^\^l  in.  When  a  case  arises  wherein 
both  moral  sense  and  reason  are  patently  lacking,  popu- 
lar opinion  pronounces  it  a  genuine  and  indubitable  case 
of  moral  imbecility.  A  concrete  case  will  illumine  this 
point. 

A  Case  of  True  Moral  Imbecility. — For  the  sake  of 
vivid  illustration  the  child  cho  en  is  strikingly  defective 
even  in  the  fundamental  similarities  between  people  which 
make  them  one  family.  He  is  not  only  idiotic  and  utterly 
animal,  but  deficient  even  in  a  sensibility  to  pain  or  pleas- 
ure. Lest  the  imagination  of  the  reader  be  overtaxed,  we 
will  describe  an  actual  case :  ^^ 

"A  teacher  of  a  special  class  in  one  of  our  large  cities 
had  an  extreme  case  of  almost  animal  grade,  a  small  boy 
who  when  given  a  knife  for  kindergarten  work  promptly 
slashed  his  neighbor's  hand;  next,  struck  a  boy  over  the 
head  with  his  hammer;  and  when  reduced  to  one  pair  of 
blunt  scissors  exercised  his  little  mentality  by  nipping  a 
piece  out  of  a  girl's  hand.  All  of  this  might  be  set  down  to 
ignorant  mischief,  though  that  is  hardly  a  tenable  hypoth- 
esis considering  the  age  of  the  boy  and  the  discipline  and 
instruction  used  in  the  first  case  of  cruelty.  The  real  situa- 
tion, namely,  a  complete  indifference  to  pain  on  his  part, 
was  revealed  by  an  accident  which  happened  one  morning 
upon  his  arrival  at  school.  He  came  in  much  excited,  eyes 
fairly  dancing  with  delight,  and  in  almost  insane  glee 
exhibited  to  the  shuddering  class  his  bloody  hand  all 
ragged  and  torn  by  the  teeth  of  a  dog  with  which  he  had 
had  an  encounter  on  his  way  from  home.  How  could  it  be 
possible  for  such  an  insensate  being  to  feel  sympathy  for 

"  TAe  Psychological  Clinic,  vol.  iv,  No.  4,  June  15, 1910,  p.  113. 


MORAL  DEVIATES  267 

others?  How  could  he  take  anything  but  delight  in  the 
bloodshed  of  others  when  he  himself  found  it  literally  the 
most  exquisite  torture  of  his  l)enighted  existence?" 

In  such  crude  and  vicious  cases  as  the  above  there  is  no 
difficulty  in  diagnosis,  though  it  might  be  worth  while  to 
remark  in  pa-^sing  that  the  American  school  system,  at 
last  accounts,  did  not  exclude  this  young  savage  from  the 
special  class.  In  other  cases,  where  the  pain  inflicted  is 
purely  mental,  popular  judgment  may  not  be  so  sure,  but 
the  underlying  psychology  of  the  operation  is  identical 
and  the  nature  of  the  infhctor  certainly  abnormal. 

In  order  to  clarify  our  conclusions  we  may  sum  them  up 
in  a  few  sentences. 

1.  The  question  whether  moral  imbecility  exists  alone, 
or  always  in  conjunction  with  mental  deficiency,  is  still 
unsettled.  There  is  no  clear  and  definite  symptom-com- 
plex by  which  the  diagnostician  may  immediately  recog- 
nize moral  imbecility  by  its  manifestations. 

2.  Moral  imbecility,  according  to  theorists,  may  be 
either  congenital  or  developmental. 

3.  The  bad  conduct  of  the  moral  imbecile  is  an  habit- 
ual expression  of  his  character,  and  not  occasional  or 
exceptional. 

4.  It  may  be  due  to  a  lack  of  moral  sense  or  of  other 
social  instincts. 

5.  It  may  be  due  to  a  lack  of  a  moral  sense  or  social 
instincts  and  reason. 

6.  The  moral  instincts  may  be  wantmg,  but  reason  may 
be  able  to  guide  the  conduct  of  the  defective  so  that  he 
does  not  break  out  into  open  criminality. 

7.  Moral  imbecility  may  express  itself  in  all  degrees  of 
bad  conduct,  and  co-exist  with  any  degree  of  mental 
defect. 


268     THE  CONSERVATION  OF  THE  CHILD 

8.  A  true  moral  imbecile  is  incorrigible.  His  disease  is 
incurable,  his  character  irreformable,  and  his  conduct 
unchangeable. 

Tredgold's  View. — In  this  conclusion,  to  which  we 
have  come  by  an  analysis  of  the  literature  of  the  subject, 
we  fuid  ourselves  in  essential  agreement  with  Tredgold, 
who  classifies  moral  imbecility  as  latent  and  actual;  and 
moral  imbeciles  as  potential  and  actual  criminals,  and 
defines  the  imbecile  as  "a  person  who  displays  from  an 
early  age,  and  in  spite  of  careful  upbringing,  strong, 
vicious  or  criminal  propensities,  on  which  punishment  has 
httle  or  no  deterrent  effect."  This  definition  tacitly  or 
expressly  includes  the  following  characteristics  of  the 
disease.  Heredity  is  hinted  at  as  a  cause  in  the  first  clause; 
lack  of  social  instincts  or  the  perversion  of  other  instincts  is 
indicated  in  the  *  strong  vicious  propensities ' ;  conduct 
comes  out  in  the  term  '  criminal ' ;  and  the  disease  is 
considered  incurable  by  punishment  or,  presumably,  by 
other  forms  of  moral  discipline  or  education.  Heredity, 
conduct  and  prognosis  are  all-important,  therefore,  in 
diagnosis. 

On  the  nature  of  the  disease  itself,  from  the  internal  or 
psychological  vie^\'point,  the  same  writer  says,  in  sub- 
stance, that  some  persons  "are  utterly  devoid  of  a  moral 
sense,  "^^  but  their  intelligence  keeps  them  from  actual 
criminality.  These  are  real  moral  imbeciles  and  potential 
criminals.  Another  class  likewise  deficient  in  moral  sense 
is  the  instinctive  or  habitual  criminals  who  may  or  may 
not  be  defective  in  intellect,  their  cunning  influencing  us 
to  one  opinion,  but  their  insensate  and  irrational  persis- 
tency in  conduct  certain  to  bring  punishment  inclining  us 

"  A.  F.  Tredgold,  Mental  Deficiency,  1908,  p.  76. 


MORAL  DEVIATES  269 

in  the  other  direction.  With  those  classifications,  as  far  as 
they  go,  we  are  in  entire  harmony,  as  our  analysis  and 
summary  show. 

With  this  statement  of  the  case  we  close  this  part  of  our 
discussion  and  turn  now  to  apply  our  theoretical  knowl- 
edge to  the  task  of  diagnosing  moral  deficiency  and 
classifying  moral  defectives. 

We  are  now  in  position  to  estimate  the  results  of  our 
investigation  into  the  history  and  analysis  of  the  ordinary 
notions  concerning  morality  by  applying  them  to  the 
classification  of  the  moral  delinquents  brought  to  the 
clinic.  The  investigation  has  not  cleared  up  all  the  con- 
cepts comiected  with  classification,  but  it  has  done  much. 
It  has  shown  that  nothing  in  the  immoral  conduct  itself  is 
sufficient  to  determine  moral  imbecility.  Moral  imbecil- 
ity may  or  may  not  be  associated  with  an  intellectual 
defect.  It  is  inherent  either  in  defects  or  the  instincts  or 
the  reason,  according  to  the  ethical  point  of  view.  The 
point  of  view  is  all-important  to  the  clinicist.  His  very 
first  practical  task  is  to  orientate  himself. 

How  the  Clinicist  Should  View  a  Moral  Delinquent. 
— What  shall  be  his  point  of  view?  From  what  angle  shall 
he  regard  his  problem?  From  the  point  of  view  of  intui- 
tive morality,  of  egoism,  of  utilitarianism  or  of  society  in 
general?  First,  he  should  remember  that  he  is  not  called 
upon  to  determine  the  morality  of  any  act  of  the  delin- 
quent, much  less  the  validity  of  any  moral  system  or  code. 
Neither  is  he  to  determine  the  morality  of  the  child  if  a 
distinction  between  the  child  and  his  act  can  be  made. 

Motives  and  Conduct. — Secondly,  he  is  not  concerned 
wholly  nor  primarily  with  motives,  but  is  concerned  with 
them  just  in  so  far  as  they  throw  light  upon  the  psycho- 
logical condition  of  the  delinquent  and  in  so  far  as  they 


270     THE  CONSERVATION  OF  THE  CHILD 

bear  upon  the  probability  of  future  repetition  of  the  same 
acts.    To  this  extent  they  must  be  considered. 

Moral  Responsibility. — Thirdly,  he  need  not  be  con- 
cerned at  all  with  moral  responsibility  except  again  in  so  far 
as  moral  responsibility  bears  upon  the  continuation  of 
the  delinquent's  conduct,  or  unless  the  clinicist  is  giving 
an  opinion  eventually  affecting  the  legal  status  of  his 
subject.  Otherwise,  he  can  adopt  a  view  of  moral  respon- 
sibility which  appears  to  be  perfectly  true  as  far  as  it  goes 
and  which  will  at  the  same  time  free  it  from  any  confus- 
ing elements.  An  illustration  will  make  this  view  clear. 
Suppose  that  two  men  lay  in  wait  for  two  other  men  and 
slew  them.  At  the  trials  of  the  two  homicides  it  is  brought 
out  that  the  same  motives  were  at  the  root  of  both  crimes, 
and  that  the  criminal  acts  were  precisely  similar.  Both 
victims  had  grievously  injured  their  slayers.  Both  slayers 
planned  their  revenge,  lay  in  wait  for  their  enemies  and 
slew  them  with  similar  weapons.  Yet  at  the  trial  one 
man  is  pronounced  a  murderer  and  sentenced  to  be  hung, 
while  the  other  is  adjudged  morally  irresponsible  and  con- 
fined to  an  insane  ayslum  for  life.  Now  what  is  the  essen- 
tial difference  between  these  two  cases?  Why  is  one  man 
called  morally  responsible  and  the  other  man  morally 
irresponsible?  As  far  as  the  psychological  clinicist  is 
concerned  he  can  assume  that  the  difference  lies  in  this 
simple  fact:  the  morally  irresponsible  man  is  one  whose 
future  actions  cannot  be  controlled  by  the  thought  of 
punishment  to  which  he  may  be  liable  for  bad  conduct  or 
the  thought  of  rewards  which  he  may  gain  by  good  conduct. 
In  other  words,  he  is  not  morally  bound  to  any  course  of 
action  and  hence  must  be  physically  restrained.  The 
problem  of  the  clinicist  then,  as  far  as  it  regards  moral 
responsibility,  is  the  determination  of  the  simple  but  very 


MORAL  DEVIATES  271 

difficult  question  as  to  whetlier  tlie  particular  delinquent 
can  be  restrained  from  bad  conduct  in  the  future  by  the 
fear  of  punishment  or  the  hope  of  reward;  or  wliether  he 
must  be  physically  restrained  from  committing  criminal 
acts.  Beyond  this,  it  is  almost  needless  to  say,  the  clin- 
icist  need  not  concern  himself  with  such  metaphysical 
questions  as  theories  of  determinism  and  free  will. 

The  position  taken  here  that  responsibility  for  wrong- 
doing is  in  reality  a  knowledge  more  or  less  vague  of  the 
consequences  of  a  criminal  act  is  in  harmony  with  that 
presented  by  Dr.  Tredgold  '^  and  summed  up  in  his  quota- 
tion from  Mercier,  "A  man  may  know  that  his  act  is 
wrong  without  knowing  how  wrong  it  is." 

This  kind  of  moral  responsibility  should  be  recognized 
by  all  those  dealing  with  mentally  defective  persons,  as  it 
is  by  all  others  in  their  treatment  of  animals.  For  no 
sensible  person  would  hesitate  to  punish  a  thieving  cat 
caught  with  its  head  in  the  cream  pitcher;  but  the 
same  person  would  not  dream  of  visiting  useless  and 
cruel  pain  upon  a  cat  three  days  after  it  had  devoured 
the  pet  canary. 

Some  people,  like  animals,  might  be  limited  to  such  a 
low  grade  of  intellect  that  the  memory  of  past  punishment 
or  the  conception  of  prospective  punishment  uwited 
would  be  too  weak  to  deter  them  from  prohibited     ^lorai.Re- 

sponsibiiity 

acts.  Certain  ones  might  be  found  with  so  short 
a  memory-span  that  misdeeds  bringing  upon  them  immedi- 
ate and  severe  punishment  would  be  committed  over  and 
over  again  because  the  remembrance  of  the  punishment — 
although  severe,  recent,  oft  repeated  and  following  imme- 
diately upon  transgression — would  still  not  be  vivid  enough 


"  A.  F.  Tredgokl,  Mental  Deficiency,  1908,  p.  76. 


272     THE  CONSERVATION  OF  THE  CHILD 

to  prevent  the  repetition  of  the  same  deed  as  often  as  the 
temptation  was  presented.  Such  a  person  would  be  called 
morally  irresponsible,  meaning  by  that  term  that  his 
future  conduct  could  in  no  wise  be  determined  by  moral 
suasion,  punishment  or  rewards. 

Still  other  individuals  might  possess  a  memory  some- 
what better  organized  so  that  only  those  comparatively 
minor  misdeeds  not  invariably  or  immediately  visited 
with  condign  punishment  would  be  forgotten.  Hence, 
though  both  classes  of  del  nquents  would  technically  be 
moral  imbeciles,  the  delinquencies  of  the  latter  would  not 
be  vicious  enough  in  the  eyes  of  society  to  classify  them  as 
such.  A  rich  man's  son  might  in  spite  of  occasional  punish- 
ment persistently  pilfer  small  sums  of  money  at  home, 
and  nothing  be  thought  of  it.  Yet  if  another  youth  fol- 
lowed exactly  the  same  course  in  a  bank  it  would  seriously 
reflect  upon  his  moral  soundness. 

The  viewpoint  which  the  clinidst  must  retain  firmly  and 
clearly  in  his  mind  is  essentially  that  of  society  in  general. 
He  must  not,  for  the  time  being,  be  an  intuitionist,  egoist 
or  utilitarian.  He  must  not,  in  the  narrow  sense,  even  be 
a  moralist.  He  must  reduce  motives,  moral  reponsibil- 
ity,  freedom  of  the  will  and  such  otherwise  and  other- 
where important  matters  to  the  minimum  required  by  his 
investigation.  He  must  concern  himself  primarily  with 
conduct.  All  other  facts  and  fictions  of  morality  must 
take  a  position  relative  to  this  finally  fundamental  factor. 
From  this  point  the  clinicist  must  begm  the  diagnosis  of 
his  case. 

As  far  as  the  conduct  of  any  moral  delinquent  is  concerned, 
it  may  present  no  exceptional  or  peculiar  form  of  badness. 
It  is  true  that  he  may  be  cruel,  but  cruelty,  at  a  certain 
age  in  a  boy's  life,  is  so  common  that  it  may  be  called 


MORAL  DEVIATES  273 

normal.^'  This  particular  boy  may  stoal,  but  stealing, 
likewise,  is  almost  universal  among  boys.  He  may  be  dis- 
obedient; he  may  lie;  he  may  play  truant;  or  he  may  swear, 
or  smoke  or  chew  tobacco,  and  on  occasion  drink  to  excess, 
but  all  of  these  actions,  single  or  in  combination,  after  a 
long  and  intense  persistence  may  suddenly  cease,  and  the 
individual  may  reform  and  live  afterward  a  perfectly  clean 
moral  life.  Consequently,  from  the  symptom-complex 
alone,  it  cannot  be  certainly  concluded  that  any  case  of 
moral  delinquency  is  permanent  or  temporary. 

What  is  true  of  conduct  is  equally  true  ofpliT/sical  appear- 
ance. In  spite  of  the  attempts  made  by  Lombroso  and 
his  school  to  mark  the  "born  criminal"  by  unmistakable 
stigmata,  the  fact  still  remains  that  stigmata  alone  have 
no  more  value  here  than  they  have  for  the  classifica- 
tion of  mental  defectives.  Even  manifestations  of  mental 
and  emotional  aberrations,  as  we  have  seen  from  our 
investigation  above,  do  not  in  themselves  and  by  them- 
selves give  a  basis  for  determining  that  any  particular 
individual  is  hopelessly  immoral. 

Hereditary  Influences  Based  upon  Statistics  Will 
Not  Help. — When  we  attempt  to  go  deeper  than  the 
symptom-complex,  or  the  external  expressions  of  moral 
imbecility,  to  ground  our  judgments  in  any  particular 
case  upon  general  principles  of  etiologj',  we  are  again  con- 
fronted with  the  difficulty  that  general  principles  based 
upon  statistics  will  not  apply  to  individual  cases.  That 
is  to  say,  while  it  may  be  possible  to  tabulate  statistics  of 
the  percentage  of  moral  degenerates  that  will  spring  from 
morally  degenerate  or  imbecile  stock,  it  by  no  means  fol- 
lows that  any  particular  individual  can  be  pronounced  a 

'» Havelock  Ellis,  The  Criminal,  1890,  p.  130. 
18 


274     THE  CONSERVATION  OF  THE  CHILD 

moral  imbecile  from  heredity  alone,  nor  can  it  be  predicted 
with  any  certainty  that  particular  parents  like  A  and  B 
will  have  particular  children  like  a  and  h  who  will  be  mor- 
ally deficient.  If  we  turn  away  entirely  from  mental  or 
hereditary  causes  of  moral  deficiency — granting  that  such 
may  exist — and  seek  for  brain  lesions,  we  again  meet  pre- 
cisely the  fame  difficulty  as  in  the  classification  of  mental 
deficiency,  namely,  that  it  is  just  as  difficult  to  diagnose  a 
cortical  lesion  as  it  is  to  diagnose  moral  imbecility. 

In  the  face  of  these  obstacles  what  then  shall  the  clinidst  do? 
He  cannot  stand  still  and  speculate  regarding  the  matter. 
It  is  not  an  abstract  or  an  academic  question.  He  is  con- 
fronted with  a  condition  and  not  a  theory.  The  condi- 
tion of  any  moral  delinquent  presented  to  him  clamors  for 
some  practical  solution.  The  parents  of  the  child  and 
society  at  large  demand  that  some  disposal  shall  be  made 
of  the  delinquent,  and  unless  the  clinician  can  classify  the 
bad  girl  or  boy  presented  to  him,  and  upon  the  basis  of 
that  classification  advise  the  best  procedure  in  each  in- 
stance, he  can  offer  no  good  reason  for  his  existence. 

Consider  for  a  moment  the  situation  that  confronts  him. 
First,  it  must  be  remembered  that  every  child  brought  to 
the  psychological  clinic  is  brought  for  some  specific  pur- 
pose. Secondly,  the  delinquent  is  brought  usually  because 
of  a  long  career  of  mischief  or  crime.  To  this  extent  he  is 
already  classified,  and,  like  his  brother  the  mental  deviate, 
is  placed  in  the  class  of  abnormal,  unusual,  or  atypical 
children  by  his  friends  and  parents.  Therefore  the  psy- 
chological clinic  has  adopted  the  name  of  "moral  deviate" 
for  all  such  cases.  Tliis  perfectly  colorless  word  was  chosen 
simply  to  signify  that  the  individual  has  departed  from 
the  customary  standard  of  morality  to  such  an  extent 
that  he  is  finally  brought  to  the  clinic  for  a  more  serious 


MORAL  DEVIATES  275 

investigation  into  his  moral  status  than  can  be  given  by 
his  unskilled  parents,  guardians,  teachers  or  friends. 

Having  made  this  one  step  towards  chissification,  we 
are  now  immediately  confronted  with  another,  just  as 
general  in  its  nature,  and  just  as  important.  This  con- 
cerns the  purpose  for  which  the  child  is  brought  to  the 
clinic.  It  is  contained  implicitly  in  the  question  upon 
the  lips  of  the  ones  who  bring  him,  "Can  you  do  any- 
thing for  this  boy?"  Or,  to  put  it  in  other  words,  "Is 
this  boy  temporarily  or  permanently  bad?"  Or,  in  still 
better  terms,  "Is  he  corrigible  or  incorrigible?"  This 
question  brings  the  clinicist  to  the  practical  problem 
already  met  in  the  classification  of  mental  deviates. 

All  Moral  Deviates  are  Corrigible  or  Incorrigible. — 
Just  as  we  have  classified  all  mental  deviates  as  curable 
or  incurable,  so  we  may  now  divide  the  moral  deviates 
likewise  into  two  groups: — the  temporary,  curable,  re- 
formable  or  corrigible  deviates,  and  the  permanent,  incur- 
able, irreformable,  degenerate,  morally  imbecilic,  or 
incorrigible  deviates.  All  these  terms  are  used  in  popular 
description,  but  in  order  to  make  our  terminology  exact 
and  conformable  to  the  divisions  already  laid  do\Mi  in 
previous  chapters  for  mental  deviates  we  will  call  the  first 
corrigible,  and  the  second  incorrigible  deviates. 

Such  classification  has  many  objections  as  well  as  viany 
advantages.  For  the  practical  purpose  of  the  psychological 
clinic  we  believe  the  advantages  far  outweigh  the  dis- 
advantages. It  lias  the  virtue  of  simplicity;  it  is  practi- 
cal, effective  and  significant.  The  assignment  of  the  child 
to  one  class  or  the  other  determines  his  disposal,  his  future 
training  and  his  treatment.  If  he  is  corrigible,  it  is  imme- 
diately the  duty  of  his  guardians  to  bring  to  bear  the 
training  or  discipline  necessary  to  correct  his  badness. 


276     THE  CONSERVATION  OF  THE  CHILD 

If,  on  the  other  hand,  he  is  incorrigible,  the  fact  must  be 
taken  as  final,  and  it  must  be  understood  that  physical 
restraint  in  some  institution  is  the  one  means  of  pre- 
venting this  potential  criminal  from  developing  into  an 
actual  criminal,  and  not  only  becoming  a  menace  to 
society  himself,  but  becoming  also  the  parent  of  like  off- 
spring. 

It  also  eliminates  a  great  many  controversies  concern- 
ing motives,  absolutism  or  relativity  of  moral  standards; 
the  moral  sense  and  moral  responsibility,  and  places  the 
emphasis  just  where  it  belongs — upon  conduct.  For  after 
all  what  parents  and  society  are  vitally  concerned  in  are 
the  actions  of  the  individual;  that  is,  either  his  actual 
criminality  or  his  actions  that  indicate  a  potential  crim- 
inality. After  the  emphasis  is  once  properly  placed,  all 
the  other  factors,  like  deranged  mentality,  cortical  lesions, 
heredity,  stigmata,  etc.,  fall  into  their  proper  relation- 
ships. Each  one  will  now  furnish  some  significant  infor- 
mation to  the  clinicist,  and  aid  him  in  deciding  the  per- 
manent condition  of  the  child. 

The  Method  of  Further  Classifying  Moral  Deviates. 
— The  further  problem  of  diagnosing  children  of  this 
class  and  the  method  of  discovering  their  condition  are 
not  widely  different  from  that  pursued  in  the  case  of 
mental  deficiency.  Neither  is  the  normal  training  vastly 
different  from  the  physiological  education  adaptable  to 
the  former  class.  "We  have  seen  more  than  once," says 
Seguin,  "how  the  moral  treatment  was  blended  with  the 
physiological  training.  We  shall  see  very  soon  the  same 
element  acting  like  a  leaven  in  labors,  occupations,  pleas- 
ures, or  claiming  its  control  over  food,  clothing,  hygiene 
or  medical  attendance.  We  find  it  everywhere;  and  it 
would  be  writing  the  same  book  over  again  from  another 


MORAL  DEVIATES  277 

standpoint  to  describe  the  working  of  this  training  in  all 
parts  of  the  treatment."-" 

We  will  now  take  up  specifically  the  method  of  decid- 
ing whether  any  case  of  moral  deviation  is  corrigible  or 
incorrigible.  In  order  to  make  the  method  clear  we  will 
sketch  a  bird's-eye  view  of  the  whole  process.  We  here 
traverse  again  the  fairly  familiar  ground  of  mental  classi- 
fication and  its  methods.  First  the  oral  examination  is 
made  of  the  parents  or  guardians  of  the  child  for  the  pur- 
pose of  securing  a  narrative  of  his  life  history,  including 
especially  a  detailed  account  of  his  conduct  and  of  any 
causes  that  may  have  brought  about  his  moral  deficiency. 
From  the  personal  history  of  the  child  we  pass  backward 
to  the  family  history,  making  note  of  any  hereditary 
influences  that  may  appear.  After  the  oral  examination 
comes  the  usual  physical  examination  for  the  purpose  of 
disclosing  the  presence  of  removable  defects  or  permanent 
stigmata.  Then  the  mental  examination  follows,  reveal- 
ing the  presence  of  any  defect  in  mentality.  To  these 
reports  a  sociological  investigation  may  be  added,  for 
neighborhood,  home-life,  and  moral  training  have  often  a 
great  deal  to  do  with  moral  incorrigibility. 

The  Oral  Examination.— That  part  of  the  oral  exam- 
ination wliich  recites  the  boy's  bad  conduct  is  uppermost 
in  the  parent's  mind  and  of  great  import  to  the  examiner. 
Although  this  has  been  the  occasion  for  bringing  him  to 
the  clinic,  it  must  be  remembered  that  no  matter  how  long 
and  how  persistently  followed  has  been  the  course  of  bad 
conduct,  this  in  itself  is  not  enough  to  prove  the  child 
morally  incorrigible.  For  it  is  not  the  persistence  of  the 
conduct   but    "the    dangerousness  of  the  criminal  that 

="  Idiocv  and  its  Treatment  by  Physiological  Method,  E.  Seguin, 
N.  Y.,  IStie,  p.  54. 


278     THE  CONSERVATION  OF  THE  CHH.D 

counts"  here  as  elsewhere.  Inquiry  must  be  carefully 
made  into  the  nature  of  his  acts  to  ascertain  their  relation, 
first,  to  the  impulses  or  instincts  giving  rise  to  them; 
and  secondly,  to  the  purpose  or  end  that  was  intended  to 
be  accomplished. 

If  there  is  a  strange  perversity  that  seems  to  lead  the 
child  to  do  things  that  are  anti-social, — if  he  steals,  for 
example,  and  seems  to  be  utterly  destitute  of  any  ability 
to  distinguish  between  the  ordinary  acts  of  appropriation 
Perverse  that  are  forbidden  and  those  that  are  permitted. 
Conduct  — j^  jjjjjy  indicate  not  that  the  individual  has 
stronger  acquisitive  instincts  than  the  normal  person,  but 
that  he  is  so  perfectly  destitute  of  respect  for  others' 
rights,  or  of  fear  for  consequences  to  himself,  that  no  coun- 
ter motives  are  present  to  hold  his  instincts  in  check. 
Therefore  he  steals  whenever  the  opportunity  occurs.  He 
steals  for  the  love  of  taking, — an  impulse  normal  to  all, — 
and  for  the  mere  delight  of  permitting  a  strong  impulse  to 
express  itself.  In  such  a  case  the  one  problem  for  the 
clinicist  is  to  discover  whether  the  child  has  mentality 
enough  to  learn  by  the  severe  consequences  which  will 
inevitably  follow  his  thieving  propensities  that  he  must 
not  give  them  indiscriminate  play.  Such  a  condition 
appears  to  be  exemplified  in  the  following  description  of  a 
peculiarly  long  and  stubborn  case  of  badness. 

C.  P.,  a  boy  twelve  years  old,  was  first  brought  to  the 
clinic  on  August  9,  1907,  on  account  of  persistent  stealing. 
A  few  days  after  his  birth  the  boy  suffered  from  a  ruptured 
eye,  the  scar  of  which  he  still  bears.  He  was  a  nervous, 
restless  baby  and  at  fifteen  months  old  was  attacked  by 
convulsions,  which  disappeared  after  circumcision.  Be- 
tween the  ages  of  two  and  three  years  he  contracted 
scarlet  fever  and  diphtheria  together,  from  the  effects  of 


MORAL  DEVIATES  27i> 

which  he  nearly  died,  and  before  he  had  fully  recovered 
from  this  illness  he  developed  pleural  pneumonia.  At  an 
early  age  he  showed  a  disposition  very  unlike  that  of  his 
brothers  and  sisters.  Although  he  saw  them  accept  their 
share  in  the  work,  he  would  not  do  anj'tliing  about  the 
house  unless  paid  for  it.  He  was  absolutely  untrust- 
worthy and  early  began  to  steal  from  his  parents.  One 
example  among  many  will  serve  to  illustrate  this  trait. 
The  family  have  several  cherry  trees  on  their  a  Persistent 
lawn,  and  when  cherries  are  ripe  the  boys  in  the  ^^^^ 

family  pick  the  fruit  for  their  mother  to  preserve.  C. 
appropriated  what  he  picked,  and  took  them  to  the  village 
and  sold  them.  Later  he  extended  his  thieving  operations 
to  the  neighbors.  At  one  time  he  purloined  a  five-dollar 
bill  from  a  pocketbook  in  a  house  where  he  went  to  visit, 
spent  part  of  it,  and  when  accused  of  the  theft  buried  the 
remainder  in  an  ash-heap.  His  pilferings  were  unremit- 
ting, full  of  cunning,  and  as  varied  as  the  means  taken  to 
prevent  them.  He  was  positively  unhapp}-^  when  not 
carrying  on  some  thievmg  exploit,  and  became  kind,  pleas- 
ant and  agreeable  when  engaged  in  the  worst  mischief. 
When  detected,  he  would  first  deny  and  then  confess  his 
acts,  and  promise  reformation.  These  spells  of  contrition, 
however,  appeared  to  be  mere  passing  moods.  The  incen- 
tive for  the  boy's  continued  thieving  came  out  in  his 
inordinate  appetite  for  sweets  and  cigarettes.  Reward, 
exhortation  and  punishment  were  alike  unavailing.  When 
locked  up  in  a  room  he  yelled  and  threw  things  out  of  the 
window  until  his  frightened  mother  released  him. 

The  physical  examination  at  the  clinic  showed  that  the 
boy,  although  small,  was  rather  well  formed,  excepting 
for  his  shallow  chest,  suggestive  of  adenoids.  A  slight 
deafness  was  evident,  his  mouth  was  kept  slightly  open, 


280     THE  CONSERVATION  OF  THE  CHILD 

his  left  nostril  was  occluded,  and  indications  of  anaemia, 
signs  of  nervousness,  and  slight  general  malnutrition  were 
present. 

Instructions  for  gymnastics  to  correct  his  bad  posture 
were  carried  out,  and  in  addition,  on  July  10th,  he  was 
taken  to  the  eye  clinic,  where  he  received  a  prescrip- 
tion for  glasses  to  be  worn  constantly  to  correct 
hyperopia.  On  July  17th  his  adenoids  and  tonsils  were 
removed. 

After  all  these  physical  defects  had  been  attended  to, 
C.  was  returned  to  his  parents,  and  in  August  of  the  same 
year  his  mother  reported  that  he  was  much  improved  not 
only  in  general  behavior,  but  in  disposition.  He  had  be- 
come more  considerate,  and  was  willing  to  do  his  share  in 
the  work ;  he  did  not  seem  so  nervous  and  sought  a  dis- 
tinctly better  class  of  friends. 

In  January,  1909,  a  different  report  came  to  the  clinic. 
C.  would,  for  a  space  of  time,  conduct  himself  properly 
and  then  give  way  to  a  "fit  of  stealing."  He  obtained 
goods  at  the  store  on  account,  sold  them,  and  spent  the 
money  in  various  forms  of  amusement.  He  lied  contin- 
uously, and  smoked  all  day  long.  In  partnership  with  his 
brother,  he  was  started  in  the  business  of  selling  eggs. 
By  earning  money  legitimately,  the  parents  hoped  that 
their  son  would  be  able  to  cast  off  his  bad  habits  of  appro- 
priating other  people's  property  in  order  to  satisfy  his 
appetite  for  sweets  and  cigarettes.  The  boys  bought  eggs 
from  a  farmer  in  the  country,  and  sold  them  in  town  at 
considerable  profit.  C.'s  business  ability  appeared  keen 
enough,  but  even  with  these  opportunities  open  to  him, 
his  dishonesty  still  cropped  out.  He  would  secure  quan- 
tities of  the  eggs  from  the  farmer,  sell  them,  receive  the 
cash,  and  then  spend  the  money  without  paying  the  farmer. 


MORAL  DEVIATES  281 

Finally  tho  business  was  closed  out,  the  parents  being 
compelled  to  pay  what  money  was  still  owed. 

All  this,  of  course,  tended  to  confirm  a  belief  in  the 
boy's  incorrigibility.  P^inally,  almost  by  accident  a  piece 
of  family  history  came  to  light  which  gave  the  whole 
matter  a  new  cast.  It  was  discovered  that  the  mother's 
father  had  led  a  dual  life,  and  had  once  failed  in  business 
under  very  suspicious  circumstances.  The  mother's  sister 
had  left  home  in  her  youth,  developed  unchastity  before 
marriage,  and  later  had  been  divorced,  though  she  after- 
ward settled  down  into  domestic  life.  The  mother's 
aunt — her  father's  sister — married  a  sailor,  who  left  her 
and  her  son,  and  she  was  also  somewhat  wild.  The  moth- 
er's own  mother  had  contracted  a  drug  habit  which  led 
her  to  take  any  means  to  satisfy  the  craving.  The  father's 
aunt  had  a  son  who  went  hopelessly  insane,  and  is  now  in 
an  asylum. 

Such  a  history  immediately  gave  the  boy's  conduct  a 
more  sinister  meaning,  but  did  not  settle  the  case.  It 
did,  however,  lead  to  the  first  steps  toward  incarcerating 
the  boy  in  a  penal  institution  where  he  would  no  longer 
be  able  to  take  advantage  of  neighbors  and  friends. 
Whether  from  fright  or  from  some  better  motive  is  not 
known,  but  from  that  day  C.'s  conduct  changed.  His 
reformation  was  marked  and  lasting.  He  ceased  all 
stealing;  later  on  secured  a  place  in  a  large  mercantile 
house,  went  to  school  at  night,  showed  complete  fidelity 
in  his  work  and  diligence  in  his  studios,  and  to-day  holds  a 
good  position  in  a  newspaper  establishment. 

Personal  History  of  the  Moral  Deviate. — If  in  addi- 
tion to  a  long  line  of  perverse  conduct  it  is  discovered 
that  the  delinquent  has  been  affected  with  some  disease 
almost  certain  to  leave  some  mark  upon  his  mentality,  it 


282     THE  CONSERVATION  OF  THE  CHILD 

is  safe  to  assume  that  both  conduct  and  disease  taken 
together  indicate  incorrigibihty,  and  especially  if  the  bad 
conduct  has  had  its  inception  immediately  subsequent  to 
the  attack  of  illness.  The  diseases  to  be  looked  for  here 
are  the  same  as  those  noted  in  our  study  of  mental  defec- 
tives, the  assumption  being  that  the  intellectual  facul- 
ties have  been  so  injured  that  the  sufferer  cannot  set 
moral  sanctions  before  his  mind  clearly  enough  to  hold 
his  anti-social  instincts  in  check,  or,  in  other  words,  to 
perform  rational  acts  of  conduct. 

What  is  true  of  disease  is  equally  true  of  injuries.  Any 
falls,  injuries,  blows  upon  the  head  or  other  physical 
Diseaaea  sliocks  should  be  investigated  with  the  case,  but 
Injuries  should  not  bc  givcn  too  much  weight,  unless 
the  series  of  bad  actions  begin  immediately  after  such 
injuries.  Even  then  the  decision  cannot  be  final.  We 
had  one  case  (No.  95)  at  the  Psychological  Clinic,  in 
which  a  boy  showed  a  most  vicious  tendency  toward  every 
form  of  bad  conduct,  including  truancy,  insubordination 
at  school,  swearing,  lying,  stealing,  threats  to  kill  his 
parents,  or  such  acts  of  violence  as  throwing  knives  at 
those  with  whom  he  became  enraged,  and  the  inception 
of  all  this  evil  temper  dated  from  an  accident  in  which 
he  was  thrown  against  a  large  stone  with  such  violence 
that  blood  exuded  from  his  nostrils  and  ears.  The  mother 
confidently  pronounced  this  to  be  the  cause  of  all  his 
badness,  and  in  the  opinion  of  teachers  and  others  this 
accident,  which  seemed  to  turn  the  boy  from  a  fairly  good 
son  into  a  demon  of  mischief,  marked  the  beginning  of 
what  had  developed  into  moral  degeneracy.  A  careful 
clinic  examination,  however,  revealed  a  history  of  diph- 
theria just  after  the  fall,  the  presence  of  adenoids,  a  de- 
flected nasal  septum  causing  almost  complete  occlusion  of 


MORAF.  DFA  lATES  283 

one  nostril,  enlarged  tonsils,  poor  vision,  impaired  denti- 
tion, entire  deafness  in  one  ear,  and  general  malnutrition. 
With  the  exception  of  the  diphtheria,  and  possibly  with 
the  exception  of  the  deafness,  which  may  have  been 
caused  by  the  blow  against  the  rock,  but  which  more 
probably  was  due  to  catarrh,  all  these  defects  were  con- 
ditions of  fairly  long  standing,  which  had  gradually 
increased  in  their  intensitj'  and  had  become  eventually 
sources  of  such  intense  irritation  that  the  boy  appeared 
to  be  morallj'  incorrigible. 

If  the  cause  lies  in  the  surroundings  it  is  usually  due  to 
bad  neighborhood,  bad  home  or  lack  of  training.  In  such 
cases,  theoretically  at  least,  the  case  is  corrigible.  An 
illustration  of  this  condition  is  offered  in  the  happy  ter- 
mination of  the  career  followed  by  a  bad  boy  suspected  at 
one  time  of  being  a  moral  imbecile. 

M.  R.,  Case  423,  was  a  boy  of  eleven  years  when  brought 
to  the  clinic  in  December,  1911,  on  account  of  moral  delin- 
quency. He  had  been  for  a  year  and  a  half  in  the  care  of  a 
missionary  society  where  he  had  been  placed  by  a  Case  of  Bad 
a  judge  in  a  neighboring  city,  partly  because  R.  E"^"'°'^™«°* 
had  been  detected  in  stealing  fruit  from  a  fruit  stand,  and 
partly  to  take  him  away  from  the  influence  of  a  bad 
brother.  While  under  the  care  of  the  society  he  had  been 
placed  in  three  or  four  homes  and  schools  with  indiffer- 
ent results.  At  none  of  the  homes  had  his  conduct  been 
satisfactory.  He  had  been  guilty  of  misdeeds  which  had 
been  described  in  such  a  way  as  to  leave  grave  doubts  in 
the  minds  of  his  guardians  as  to  his  moral  soundness.  A 
close  examination  into  the  nature  of  his  acts,  however, 
which  were  said  to  be  exceedingly  vulgar,  revealed  no 
tendencj''  which  could  not  be  attributed  to  his  home 
environment  or  his  circumstances. 


284     THE  CONSERVATION  OF  THE  CHILD 

His  people  were  Swiss  and,  as  far  as  can  be  learned,  on 
his  father's  side  the  grandparents  are  respectable  and 
hard-working  people.  His  mother's  grandparents,  however, 
had  lived  a  "pretty  rough  life."  The  grandfather  was  a 
scissors-grinder,  and  he  and  his  wife  wandered  about  the 
country  doing  odd  jobs.  Their  daughter,  the  mother  of 
the  boy,  is  a  huge  woman,  crippled  so  that  she  cannot 
walk,  with  a  dull,  heavy  appearance,  possibly  due  to  the 
shut-in  life  that  she  leads.  To  add  to  the  other  sinister 
influences,  two  boarders  of  very  low  character  were  kept 
in  the  family.  One  of  these,  evidently  feeble-minded, 
described  as  wild  and  uncouth  looking  in  the  extreme,  was 
a  brother  of  the  boy's  maternal  grandmother.  There 
were  five  children  in  the  immediate  family,  of  whom  the 
eldest  was  placed  in  a  reformatory  on  account  of  general 
incorrigibility.  The  boy  we  are  considering  was  arrested 
at  the  age  of  nine  on  the  charge  of  petty  larceny. 

The  physical  examination  at  the  clinic  showed  the  boy 
to  be  in  fairly  good  condition,  of  the  usual  height  and 
weight  for  a  boy  of  his  age,  with  an  upper  chest  expansion 
of  two  inches,  and  a  lower  of  two  and  one-quarter  inches. 
His  head,  ears  and  eyes  were  normal.  His  tonsils  were 
enlarged,  and  the  septum  of  his  nose  deflected  to  the 
right. 

To  the  mental  tests  he  gave  normal  reactions,  working 
the  form  board  correctly,  and  naming  the  common  colors 
except  orange  and  black,  the  names  of  which  he  learned 
at  the  clinic.  His  visual  memory  span  was  good  for  three 
colors.  The  Binet  test  showed  him  to  be  mentally  over 
ten  years  old.  He  was  fond  of  reading  fairy  tales,  spelled 
third-grade  words,  but  did  second-grade  arithmetic  poorly. 
He  did  not  seem  to  be  fond  of  working  with  tools,  and 
apparently  had  no  way  of  occupying  himself  in  spare 


MORAL  DEVIATES  285 

moments,  for  his  life  had  been  so  irregular  that  ho  had 
never  learned  the  customary  games  of  boys. 

After  this  examination,  it  was  recommended  that  the 
boy  be  examined  for  nose  and  throat  obstructions,  and  on 
account  of  the  statement  of  his  teacher  and  others  that  he 
was  normally  imbecilic,  it  was  thought  best  to  place  him 
in  an  institution  for  observation.  In  the  meantime  he 
was  kept  at  the  House  of  Detention.  A  letter  from  the 
superintendent  stated  that  the  boy  displayed  usual  mental 
ability  in  his  school  work,  that  he  was  of  an  affectionate 
disposition  but  of  a  rather  fiery  temper  when  aroused, 
and  that  in  the  writer's  judgment  he  was  morally  an 
average  boy,  with  ability  to  succeed  in  class  work,  pro- 
vided he  could  be  sent  to  school  regularly. 

In  April,  1911,  he  was  admitted  to  a  self-governing  col- 
ony for  observation.  After  some  months  a  report  came 
from  the  colony  averring  that  R.  was  the  best  boy  they 
had  ever  had,  and  upon  the  strength  of  this  record  he  was 
adjudged  mentally  normal,  and  placed  in  a  family  where 
he  now  is. 

This  is  a  case  where  the  moral  delinquency  was  undoubt- 
edly due  to  the  home  training  and  bad  environment.  The 
method  of  determining  the  moral  status  of  the  boy  was 
simple.  It  consisted  in  a  physical  and  mental  examination 
which  found  no  cause  of  moral  imbecility  in  the  boy  him- 
self, and  in  placing  him  where  the  effect  of  good  conduct 
could  be  accurately  observed. 

The  Family  History.— After  the  delinquent's  personal 
history,  an  investigation  into  his  family'  history  logically 
follows.  It  will  be  remembered  from  our  study  of  author- 
ities that  many  writers  attribute  moral  imbecility  to  hered- 
ity alone,  though  some,  like  Tredgold  for  example,  believe 
that  it  may  develop  at  an  early  age  and  therefore  distin- 


286     THE  CONSERVATION  OF  THE  CHILD 

guish  between  hereditary  and  developmental  imbecility. 
Upon  such  a  basis  the  hereditary  disease  might  be  called 
moral  imbecility  proper,  and  that  which  develops  post- 
natally,  moral  degeneracy.  From  our  point  of  view, 
which  regards  incorrigibility  as  the  essence  of  moral  imbe- 
cility, such  a  distinction  is  a  secondary  consideration. 
In  so  far  as  the  concept  of  hereditary  moral  imbecility  is 
concerned,  its  meaning  has  not  been  definitely  analyzed 
beyond  the  signification  of  an  inevitable  predestination 
to  badness,  which  means  practically  nothing  more  than 
that  all  possible  means  have  been  brought  to  bear  to 
effect  the  transgressor's  reformation,  and  that  all  have 
failed.  As  far  as  heredity  covers  up  ignorance  or  is  ap- 
pealed to  as  an  excuse  for  ineffective  moral  training,  it  is 
of  small  help  to  the  diagnostician. 

It  may,  however,  compel  extra  precautions  to  be  taken 
with  some  children  whose  parents'  lives  give  a  sinister 
signification  to  the  children's  pranks,  which  might  be 
otherwise  considered  mere  temporary  impulses  to  mischief. 
In  the  following  case,  heredity  alone  played  the  really 
causal  part  in  the  decision  to  act  quickly  and  thoroughly 
in  the  disposal  of  the  matter. 

M.  R.,  Case  210,  is  a  fine-looking,  manly  boy  about 
twelve,  coming  from  a  cultured  family,  with  every  air  of 
good  breeding  and  quiet  gentlemanliness  in  his  appear- 
ance. He  shows  no  marked  abnormalities  and  no  physical 
stigmata.  He  is  a  little  backward  in  his  school  work,  a 
matter  easily  accounted  for  by  frequent  changes  of  schools. 
His  moral  delinquencies  are  of  a  mild  order — the  very 
common  one  amongst  boys  of  appropriating  money  at 
home,  and  a  tendency  to  choose  his  companions  from  a 
lower  social  and  moral  level  than  would  be  expected  from 
one  of  his  station.    Taken  in  themselves  his  aberrations 


MORAL  DEVIATES  287 

are  not  nearly  so  serious  nor  so  marked  as  might  be  found 
among  boys  in  an  average  pul)lic  school.  However,  both 
the  seriousness  and  the  frequency  of  his  delinquencies 
were  on  the  increase. 

The  item  which  overtops  all  others  in  gravity  in  this 
case  is  the  heredity.  The  father  contracted  tuberculosis, 
of  which  both  his  father  and  mother  had  died,  a  Case  of 
He  did  not  succumb  to  the  disease,  but  he  did  ""'  "*' 
fall  into  some  dissipation  not  more  unusual  than  that  of 
many  men  in  his  station  and  w'ith  his  rearing,  but  gross 
enough,  and  intense  enough  while  it  lasted.  However,  as 
his  immoralities  began  after  the  birth  of  this  boy,  they 
cannot  1)0  said  to  have  any  direct  influence  through  con- 
stitutional deterioration  and  consequent  effect  upon  the 
germplasm.  Besides  the  father's  inheritance  of  the  tuber- 
cular diathesis,  serious  hereditary  history  is  to  be  found 
on  the  mother's  side.  Her  sister  died  insane.  Her  father's 
brother  was  an  imbecile  and  one  of  his  sisters  was  the 
mother  of  an  imbecile  girl.  On  the  mother's  maternal 
side  was  also  a  taint.  Her  mother's  sister  had  a  daughter 
who  grew  up  immoral  and  dissipated. 

Under  such  circumstances,  even  the  mildest  sjonptoms 
of  moral  deficiency,  and  especially  since  these  were  in- 
creasing in  intensity,  caused  at  once  the  gravest  appre- 
hension and  called  for  immediate  and  most  skilled  train- 
ing to  avoid  a  repetition  of  the  same  troubles  that  had 
occurred  with  the  ancestors. 

The  first  requisite  was  to  see  that,  as  far  as  possible, 
the  physical  condition  of  the  boy,  which  was  excellent, 
should  be  kept  strictly  up  to  a  high  standard,  for  a  sound 
body  shuts  many  gates  to  moral  disease.  The  best  envir- 
onment possible  was  the  next  consideration.  A  good 
school  with  sports,  which  demand  strong,  vigorous,  manly 


288     THE  CONSERVATION  OF  THE  CHILD 

self-expression,  with  out-door  associations,  plenty  of 
blood-cleansing,  fresh  air,  and  every  antidote  to  list- 
lessness,  idleness,  speculation,  or  brooding,  was  sought 
and  found. 

A  place  in  a  private  school  in  the  country,  with  excellent 
moral  and  physical  environment  and  all  the  activity  a 
boy  could  crave,  was  secured  for  him,  and  in  the  last  year 
and  a  half  no  trouble  has  been  experienced.  On  the  con- 
trary, R.'s  reports  have  been  excellent.  Whether  or  not 
he  will  be  strong  enough  to  throw  off  the  incubus  of  such 
a  burdensome  heritage  which  has  already  shown  evidences 
of  its  potentialities  remains  to  be  seen.  So  important  is  it 
that  in  spite  of  every  other  salutary  feature  of  the  case 
the  cautious  clinicist  will  suspend  judgment  until  this  boy 
reaches  manhood. 

Finally,  when  bad  heredity  and  bad  environment 
coalesce  in  one  individual  and  to  innate  worthlessness  are 
added  physical  defects,  and  the  physical  and  moral  dis- 
ease of  a  pauperized  home,  neglect  of  training  and  a  neigh- 
borhood destitute  of  any  uplifting  circumstances,  moral 
delinquency  is  almost  sure  to  follow.  If,  further,  by  the 
process  of  elimination,  environmental  or  disciplinary 
factors  are  accounted  for,  as,  for  example,  when  the  per- 
sistent career  of  moral  delinquency  continues  in  spite  of 
a  change  to  the  best  moral  training  and  the  best  environ- 
ment, and  clear  evidence  is  present  of  imbecility,  insanity, 
or  moral  degeneracy  in  the  parents,  we  have  a  solid  foun- 
dation for  concluding  that  the  badness  is  incorrigible. 

In  this  following  description  of  S.  M.  we  find  nearly  all 
the  factors  present  for  the  generation  and  nurture  of  the 
juvenile  delinquent,  and  the  failure  of  all  efforts  made  to 
save  her  must  lead  us  to  the  conviction  that  she  is  a  "born 
criminal." 


MORAL  DEVIATES  289 

S.  M.,  Case  6,  was  a  girl  eiglit  years  old  when  brought 
to  the  clinic  in  November,  1909,  by  her  motlier,  who  was 
sent  by  the  Children's  Aid  Society,  where  the 
child  had  been  referred  by  the  principal  of  the  Heredity  and 

Environment 

school,  on  account  of  her  exceedingly  bad  con- 
duct.   The  girl  had  begun  school  at  seven  years,  but  on 
account  of  irregularity  in  attendance  and  bad  home  con- 
ditions had  made  practically  no  progress. 

Her  physical  examination  had  been  begun  in  school, 
where  the  medical  examiner  found  that  she  had  adenoids, 
and  recommended  an  operation  which  had  been  performed 
three  months  previous  to  her  visit  to  the  clinic.  The 
physical  examination  at  the  clinic  revealed  no  abnormal- 
ities or  stigmata,  and  only  a  slight  defect  in  any  of  the 
special  senses.  Her  eyes  were  later  tested  and  fitted  with 
glasses.  In  general  appearance  she  was  a  most  pleasing 
looking  child  with  a  frank,  open  face,  large  gray  eyes,  long, 
glossy,  curly  hair,  full  cheeks  and  a  good  complexion.  She 
stood  erect  with  her  shoulders  thro\\Ti  back,  and  impressed 
everyone  as  being  a  child  of  more  than  ordinarily  good 
temper  and  disposition.  The  only  noticeable  defect  was 
an  infantile  stammer  and  a  fiat  voice,  probably  due  to 
catarrhal  conditions.  In  July,  1909,  the  speech  defect 
was  reported  by  a  specialist  as  due  to  nervousness.  When 
the  child  was  careful  and  spoke  slowly,  her  articulation 
was  almost  perfect. 

The  mental  examination  showed  that  she  was  much 
retarded.  She  knew  very  little  of  arithmetic,  and  could 
add,  subtract  and  multiply  only  in  the  simplest  numbers. 
She  knew  her  colors  and  worked  the  form  board  slowly. 
Her  reading  in  the  First  Reader  was  poor,  though  she  was 
said  to  be  extremely  fond  of  books.  The  report  from 
school  at  that  time  said  that  she  was  doing  good  work  in 

19 


290     THE  CONSERVATION  OF  THE  CHILD 

her  grade,  which  was  the  lowest  in  the  school.  Much  of 
this  improvement  came  after  the  removal  of  the  adenoids, 
before  which  she  was  reported  to  be  highly  nervous  and 
quite  deaf,  always  complaining  of  ear-ache. 

Her  life  history  was  quite  in  line  with  her  mental  con- 
dition. She  weighed  six  pounds  when  she  was  born;  the 
delivery  was  difficult,  necessitating  the  use  of  instruments, 
which  left  the  baby  partially  asphyxiated  for  some  time. 
She  was  artificially  fed  on  barley  water  and  whiskey  until 
she  was  a  year  and  a  half  old.  She  cried  a  great  deal,  did 
not  sleep  well,  and  in  every  way  was  reported  different 
from  the  other  children  in  the  same  family.  She  did  not 
begin  to  walk  until  two  years  old  nor  talk  until  four 
years.  She  had  measles  three  times,  whooping  cough, 
pneumonia,  and  was  troubled  with  enuresis  at  the  time 
of  her  examination. 

The  family  history  added  no  favorable  facts  to  the 
situation.  There  were  nine  children  in  the  immediate 
family,  five  of  whom  were  dead,  four  of  marasmus  and 
one  of  brain  fever.  The  mother  was  in  poor  health  before 
M.  was  born,  but  was  compelled  to  work,  taking  in  wash- 
ing. The  mother's  father  died  of  tuberculosis,  when  the 
mother  was  only  one  month  old.  The  father  of  the  girl 
had  always  been  well  up  to  the  time  of  an  attack  of  rheu- 
matism. He  had  one  sister  who  was  paralyzed.  The  man 
was  the  driver  of  a  wagon;  was  ignorant  and  uncouth. 
The  environment  of  the  child  was  bad  in  every  way.  The 
home  was  poor  and  in  constant  need.  Charitable  organi- 
zations were  called  in  frequently  to  assist  the  family  with 
the  necessities  of  life.  Several  of  M.'s  brothers  and  sisters 
had  already  attained  to  an  unsavory  reputation,  especially 
the  oldest  girl,  who  was  married.  The  second  daughter, 
though  of  better  reputation,  was  quite  unwilling  to  assist 


MORAL  DEVIATES  291 

the  family  in  any  way.  One  of  the  boys  had  been  four 
years  in  the  House  of  Refuge,  and  after  leaving  there 
had  been  unable  or  unwilling  to  hold  a  position  and  had 
degenerated  into  a  vagabond.  His  brother,  seventeen 
years  old,  was  a  hard-working,  industrious  man  without 
much  learning  or  ability,  employed  as  a  teamster, 
earning  eight  dollars  a  week,  all  of  which  ,he  gave  to  his 
parents. 

The  girl,  therefore,  entered  life  handicapped  both  with 
a  bad  family  history  and  with  a  poor  environment.  In 
August,  1909,  she  was  sent  to  a  Convalescent  Home  for 
Children  in  the  country,  where  she  remained  two  weeks 
and  obtained  her  first  experience  in  a  pleasant  and  healthy 
home.  As  a  result  her  conduct  was  reported  to  be  excel- 
lent, and  the  child  seemed  to  be  obedient  and  happy  in 
every  way.  In  October,  1909,  it  was  necessary  to  trans- 
fer her  from  the  public  school  which  she  had  been  attend- 
ing. This  was  the  beginning  of  a  series  of  misfortunes  for 
the  child.  Her  progress  in  school  was  not  good.  She  was 
again  brought  to  the  Psychological  Clinic  in  November, 
1909,  and  referred  to  the  eye  clinic,  where  her  eyes  were 
fitted  with  glasses.  In  the  early  part  of  December  her 
mother  had  a  second  paralytic  stroke,  which  threw  the 
child  largely  upon  her  own.  resources.  Her  conduct  be- 
came so  flagrant  that  a  policeman  threatened  to  take  her 
to  the  station  house.  She  spent  her  time  on  the  street, 
stealing  rides  on  ice-wagons,  and  conducting  herself  gen- 
erally in  a  disorderly  manner.  Under  these  circumstances 
it  was  thought  best  to  take  M.  from  her  home.  The 
clinic  secured  a  temporary  boarding-house  in  the  country, 
where  her  conduct  was  soon  reported  to  be  unbearable. 
In  January,  1910,  she  was  transferred  to  the  Woman's 
Hospital  for  a  second  operation  for  adenoids,  and  for 


292     THE  CONSERVATION  OF  THE  CHILD 

the  enuresis.  Here  her  physical  condition  immediately 
improved,  but  her  conduct  was  so  vicious  that  in 
April  it  was  found  necessary  to  remove  her  from  that 
institution. 

She  was  then  taken  into  the  home  of  the  social  worker 
who  had  done  so  much  for  her,  and  had  been  her  constant 
friend  and  guardian  from  May,  1909.  In  spite  of  the 
social  worker's  influence  and  the  very  kindest  treatment 
that  could  be  given  the  child,  her  conduct  continued 
unchanged.  Her  impertinence  and  disobedience  were 
outrageous;  and  she  was  therefore  placed  in  one  of  the 
care-taking  homes  of  the  clinic,  and  entered  in  the  first 
grade  in  a  neighboring  public  school.  For  five  weeks  her 
conduct  was  good  and  progress  fair. 

About  this  time  an  opportunity  was  found  to  place 
her  in  a  children's  village  near  Philadelphia,  for  obser- 
vation under  the  most  healthful  and  satisfactory  environ- 
ment. 

During  her  vacation  M.  was  taken  to  the  sea-shore  by 
her  friend  the  social  worker,  where  her  old  trouble,  ear- 
ache, again  developed,  and  it  was  found  that  both  ear- 
drums were  perforated.  At  the  end  of  her  vacation  she 
was  returned  to  the  village,  but  there  was  no  reformation 
in  her  character.  She  was  reported  quarrelsome,  disobe- 
dient, impertinent,  used  improper  and  vile  language  to 
the  other  children,  and  had  a  marked  and  vicious  prefer- 
ence for  boys'  society.  She  did  not  improve  in  her  reading, 
but  liked  sewing  and  manual  work,  which  she  did  fairly 
well.  Eventually  it  was  found  impossible  to  continue  her 
in  the  institution  and  she  was  finally  committed  to  a 
reformatory  institution  for  girls. 

This  is  one  of  the  cases  in  which  moral  degeneracy  is 
due  to  a  complication  of  causes, — to  a  poor  heredity, 


MORAL  DEVIATES  293 

bad  home  environment,  and  vicious  neighborhood,  aug- 
mented by  the  presence  of  physical  defects  and  diseases. 
These  influences,  in  spite  of  eighteen  months  of  careful 
attention,  the  aid  of  six  institutions,  five  physicians  and 
several  friends,  and  the  expenditure  of  several  hundred 
dollars,  proved  so  strong  that  no  permanent  improvement 
in  character  or  conduct  can  fairly  be  expected.  Though 
attractive  in  personal  appearance,  and  seemingly  possess- 
ing many  potentialities  for  good,  this  child  was  hopelessly 
lacking  in  any  moral  sense  and  impervious  to  any  elevat- 
ing ideals.  The  short  sketch  given  here  fails  to  give  more 
than  the  faintest  idea  of  the  viciousness  of  her  acts,  her 
impertinence,  vileness,  disobedience,  sexual  immoralities, 
and  depraved  tastes.  Heredity  and  early  environment 
had  worked  together  too  long  to  be  overcome. 

The  Physical  Examination  and  Stigmata  of  De- 
generacy.— Having  exhausted  the  oral  lines  of  examina- 
tion, we  now  turn  to  the  subject  himself  and  make  a 
physical  examination  for  the  purpose  of  distinguishing 
between  the  removable  physical  defects  and  the  congen- 
ital stigmata.  Here  the  same  processes  must  be  followed 
as  have  been  described  with  the  mental  deviate.  To  that 
discussion  we  have  little  to  add,  except  to  mention  that 
with  some  writers,  notably  Lombroso  and  his  school,  the 
physical  characteristics  of  the  born  criminal  have  been 
magnified  to  a  place  of  importance  in  the  classification  of 
anthropological  types  hardly  justified  in  common  sense  by 
the  results.  In  his  work  on  The  Criminal,  Havelock  Ellis 
devotes  a  chapter  to  their  physical  characteristics,  treat- 
ing the  anomalies  of  the  skull,  face,  hair,  physiognomy, 
trunk  and  viscera,  but  admits  that  not  only  is  the  science 
of  anthropology  so  inexact  that  it  affords  little  precise 
data  on  this  subject,  but  that  the  descriptions  of  criminals 


294     THE  CONSERVATION  OF  THE  CHILD 

given  by  experts — or  even  of  the  same  criminal  by  the 
same  expert  on  two  occasions — differ  so  radically  that 
Marks  they  are  worthless  for  yielding  any  true  impres- 
Criminais  sion  of  the  Criminal  described.  He  also  greatly 
circumscribes  the  value  claimed  for  physiognomical  studies 
by  the  earlier  Italian  criminologists,  saying: — "There  is, 
in  the  opinion  of  many  of  the  Italian  anthropologists,  a 
special  physiognomy  for  different  crimes,  though  this 
statement  is  qualified  by  the  well-known  fact  that  quite 
different  crimes  may  be  committed  by  the  same  person. 
Dr.  Marro,  in  his  Caratteri  del  Delinquenti,  describes  no 
fewer  than  eleven  different  classes  of  criminals,  though 
the  distinctions  are  not  all  physiognomical.  Professor 
Lombroso's  descriptions  are,  however,  the  most  vigorous 
and  picturesque,  though  it  is  scarcely  possible  to  receive 
them  without  qualification.  Thieves  he  describes  as  fre- 
quently remarkable  for  the  mobility  of  their  features  and 
of  their  hands;  the  eyes  are  small  and  very  restless,  the 
eyebrows  thick  and  close,  the  nose  often  crooked  or  in- 
curved, the  beard  thin,  the  forehead  nearly  always  nar- 
row and  receding,  the  complexion  pale  and  yellowish, 
and  incapable  of  blushing.  In  those  guilty  of  sexual 
offences  Lombroso  finds  the  eyes  nearly  always  bright; 
the  voice  either  rough  or  cracked;  the  face  generally  deli- 
cate, except  in  the  development  of  the  jaws,  and  the  lips, 
and  the  eyelids  swollen;  occasionally  they  are  hump- 
backed or  otherwise  deformed.  Sometimes  in  incendiaries 
Lombroso  has  noted  a  peculiar  delicacy  of  the  skin,  an 
infantile  aspect,  and  abundance  of  hair,  occasionally 
resembling  a  woman's.  The  eye  of  the  habitual  homicide 
is  glassy,  cold  and  fixed;  his  nose  is  often  aquiline,  beaked, 
reminding  one  of  a  bird  of  prey,  always  voluminous; 
the  jaws  are  strong;  the  ears  are  long;  the  cheek-bones 


High-grade  moron.      Xogroid 
type  of  profile. 


A  Cretin  girl.     Typical  po.sition 
of  the  tongue. 


A  ease  of  extreme  moral  delin- 
quency.    Age  10  years. 


Middle-grade  moron- 
Mongoloid. 


MORAL  DEVIATES  295 

large;  the  hair  dark,  curling,  abundant;  the  beard  often 
thin;  the  canine  teeth  much  developed;  the  lips  thin; 
nystagmus  frequent;  also  spasmodic  contractions  on  one 
side  of  the  face,  by  which  the  canine  teeth  are  exposed. 
The  forger  and  sharper,  on  the  other  hand,  has  frequently 
a  singular  air  of  bonhomie,  a  kind  of  clerical  appearance 
which  is  indeed  necessary  in  his  business,  because  it  in- 
spires confidence.  Some  have  angelic  faces;  others  are 
small,  pale  and  haggard.  The  prisoner  also  frequently  has 
a  peculiarly  benevolent  aspect.  'In  general,'  Lombroso 
concludes,  'bom  criminals  have  projecting  ears,  thick 
hair,  a  thin  beard,  projecting  frontal  eminences,  enormous 
jaws,  a  square  and  projecting  chin,  large  cheek-bones  and 
frequent  gesticulation.  It  is,  in  short,  a  type  resembling 
the  Mongolian,  or  sometimes  the  Negroid.'" 

The  Psycho-Physical  Tests. — Finally  we  have  come 
to  the  mental  tests  proper.  Here  it  must  be  kept  in  mind 
that  we  are  seeking  to  establish  the  presence  or  the  absence 
of  certain  instincts  and  of  certain  rational  powers.  Already 
the  oral  examination  has  revealed  much  information  re- 
garding l)oth  these  points.  The  conduct  of  the  child,  the 
nature  of  his  acts,  his  reaction  to  punishment,  his  expres- 
sions of  sensibility  to  pain,  his  irrational  persistence  in 
useless  crime  in  the  face  of  severe  punishment — all  go  to 
show  whether  his  instincts  are  normal  and  his  interests 
healthy. 

The  information  thus  given  can  be  substantiated  by 
certain  tests  for  sensitivity.  The  algometer  and  aesthesi- 
ometer  will  reveal  any  abnormalities  in  such  fundamental 
capacities  as  pain  and  pleasure  sensitivit3\  The  same 
tests  can  be  more  simply  made  by  pricking  the  child's 
hand  with  a  pin  or  by  pinching  it  severely.  We  have  had 
children  who  would  hardly  flinch  under  the  severest  tests 


296     THE  CONSERVATION  OF  THE  CHILD 

of  this  kind.  Cases  have  also  been  recorded  where  the 
children  have  sucked  the  flesh  from  off  their  fingers  with- 
out apparently  feeling  any  pain.  The  instance  already 
referred  to  in  this  chapter  was  one  of  such  a  low  type  of 
insensate  creature.  The  same  insensibility  has  been 
remarked  by  other  observers.    Havelock  Ellis  writes: 

"The  physical  insensibility  of  the  criminal  has  indeed 
been  observed  by  every  one  who  is  familiar  with  prisons. 
In  this  respect  the  instinctive  criminal  resembles  the  idiot 
to  whom,  as  Galton  remarks,  pain  is  a  welcome  surprise." 
He  may  even  be  compared  with  many  lower  races,  such 
as  those  Maoris  who  did  not  hesitate  to  chop  off  a  toe  or 
two,  in  order  to  be  able  to  wear  European  boots.  Dr. 
Felkin  found  the  maximum  distance  at  which  two  points 
of  a  compass  could  be  distinguished  at  the  tip  of  the  tongue 
was  in  an  average  European  1.1  mm.,  in  a  Soudanese  2 
mm.,  in  a  negro  3  mm. 

"Lauvergne  mentions  a  convict  imprisoned  for  life,  who 
smiled  with  pleasure  when,  moxas  having  been  applied  to 
Insensibility  bim,  hc  saw  his  skin  burning  and  heard  it  crack, 
of  Criminals  g^^.^    _  _    ^^^^  j^jjjg^  ^jg  brothcr  and  his 

father),  Lombroso's  favorite  typical  case  of  'moral  insan- 
ity,' was  found  by  Tamburini  and  Sepilli  to  be  without 
perception  of  pain  when  tested  with  a  needle.  Other 
criminals  have  been  found  very  deficient  in  sensibility  to 
the  electric  current.  .  .  .  Dr.  Penta,  in  the  course  of 
his  elaborate  researches,  found  that  the  majority  of  his 
184  instinctive  criminals  at  Santo  Stefano  were  insensible 
to  the  pain  of  punctures,  burns,  cuts,  and  even  grave 
surgical  operations.  'I  have  extirpated  tumors,'  he 
remarks,  '  of  considerable  size,  in  the  back  and  neck,  with- 
out the  necessity  of  producing  anaesthesia  and  without 
causing  pain;   in  a  case  of  feigned  epilepsy  ammonia  to  the 


MORAL  DEVIATES  297 

nose  caused  no  reflex  phenomenon  and  deep  puncture 
and  burning  of  the  skin  produced  no  painful  contraction.' " 
.  .  .  "Working  with  Du-Bois  Reymond's  electrical 
apparatus,  in  conjunction  with  Marro,  he  found  the  sen- 
sibility of  the  criminals  much  inferior  to  that  of  the  nor- 
mal person  examined.  Swindlers  possessed  greater  sensi- 
bility than  murderers  or  thieves.  Marro  found  sensibility, 
measured  by  an  sesthesiometer,  most  obtuse  in  murderers 
and  incendiaries.  Similar  results  were  obtained  by  Kamlot 
in  reference  to  tactile  sensibility;  he  examined  103  crim- 
inals and  27  normal  persons  and  found  obtusity  in  44 
per  cent,  of  the  former  and  in  only  29  per  cent,  of  the 
latter.  It  should  be  noted  that  cases  of  excessive  sensi- 
bility, due  either  to  extreme  pusillanimity,  or  to  some 
morbid  condition  of  the  skin  or  brain,  are  also  found 
among  criminals." 

Mental  Tests. — The  tests  for  reasoning  powers,  like 
other  mental  tests,  are  involved  in  a  great  many  difficulties. 
Such  simple  tests  as  problems  in  arithmetic,  the  solution 
of  some  problem  requiring  practical  wisdom,  or  the  per- 
formance of  .some  simple  task  involving  the  choice  of  a 
means  to  an  end,  obedience  to  commands,  the  working  of 
a  puzzle,  or  similar  experiments,  show  a  child's  rationality 
with  fair  accuracy,  and  will  surely  reveal  any  serious 
aberrations  in  this  crowning  faculty  of  the  human  mind. 

The  Sub -classification  of  the  Incorrigible  Moral 
Deviate. — After  the  main  question  of  the  corrigibility  or 
the  incorrigi})ility  of  moral  delinquency  has  been  settled, 
the  sub-classification  of  the  subject  remains  to  be  com- 
pleted. Different  authors  give  different  sub-classifications. 
Thus,  Dr.  Barr,  following  Dr.  Kerlin,  correlates  the  moral 
imbeciles  with  his  sub-classes  of  mental  imbeciles.  Accord- 
ing to  this  arrangement,  measured  by  their  mental  capac- 


298     THE  CONSERVATION  OF  THE  CHILD 

ity,  moral  imbeciles  are  low-grade,  middle-grade  and  high- 
grade,  with  the  following  moral  characteristics  respectively. 
The  low-grade  moral  imbecile  is  bestial  and  cruel,  having 
delight  in  open  criminal  acts,  carried  out  with  an  animal 
stubbornness  and  stupidity.  The  middle-grade  moral  im- 
becile finds  his  delight  chiefly  in  mischief  which  expresses 
his  entire  lack  of  any  altruistic  impulses.  He  has  no  regard 
for  the  rights  of  others  and  performs  his  mischief  chiefly 
for  the  excitement  of  accomplishment  and  the  satisfaction 
of  his  egotistic  desires.  The  high-grade  moral  imbecile 
exhibits  far  more  refinement  of  evil,  coupled  with  a  men- 
tality which  enables  the  evil-doer  to  carry  out  his  plans 
with  long  and  exceedingly  cunning  preparation.  He 
exhibits  no  moral  sense  and  does  not  seem  to  have  reason 
enough  to  understand  that  his  actions  will  ultimately 
deprive  him  of  the  privileges  which  he  covets.  Often- 
times this  disposition  is  associated  with  an  entire  absence 
of  stigmata  with  great  physical  beauty  and  with  a  peculiar 
innocence  or  saintliness  of  expression,  which  immediately 
strikes  the  spectator  unacquainted  wdth  the  real  situation, 
and  enlists  his  sympathy  for  the  degenerate. 

In  all  these  cases  a  knowledge  of  right  and  wrong  may 
exist.  Sometimes  this  is  limited  to  concrete  cases  or  actions 
without  the  corresponding  knowledge  of  right  and  wrong  in 
the  abstract.  Thus,  lying  may  in  general  not  be  thought 
to  be  wrong,  though  any  particular  lie  is  admitted  to  be 
wrong.  On  the  other  hand,  the  opposite  may  be  true, 
and  the  moral  imbecile  may  admit  right  and  wrong  in 
the  abstract  with  perfect  freedom,  while  he  may  seem  to 
possess  no  comprehension  of  a  wrong  deed. 

i 


IX. 
SOCIOLOGICAL   RELATIONS  OF  THE   CLINIC 

The  sociological  importance  of  the  Psychological  Clinic 
has  been  hinted  at  more  than  once.  Its  relations  to  the 
past  have  been  outlined  in  the  historical  sketch  in  the  first 
chapter.  There  the  clinic  was  set  forth  as  the  latest 
social  expression  of  a  long  scientific  development.  But  it 
is  something  more  than  a  scientific  organization  devoted 
to  an  abstract  purpose  and  cloistered  within  the  confines 
of  scholastic  interests.  It  is  also  a  social  enterprise,  not  a 
small,  self-contained,  and  unrelated  social  agency,  origi- 
nating and  working  within  its  own  peculiar  field  without 
regard  to  society  at  large,  but  it  is  an  organization,  both 
scientific  and  practical,  devoting  itself  to  a  field  not  occu- 
pied by  any  other  social  structure.  This  aspect  of  the  clinic 
has  been  sufficiently  dwelt  upon  in  preceding  chapters. 
In  them  the  reader  must  have  frequently  caught  sight  of 
the  background  of  social  institutions,  homes,  schools, 
societies,  reformatories,  clinics,  and  hospitals, — without 
which  the  varied  tasks  of  the  Psychological  Clinic  could 
never  be  performed  From  this  point  of  view  the  clinic  is 
merely  one  specialized  organ  in  the  economy  of  society  as 
a  whole  and  is  dependent  for  existence  and  function  upon 
many  other  coordinate  social  organizations.  In  dealing 
with  this  aspect  of  the  clinic  we  will  endeavor  to  sum- 
marize the  multifarious  relationships  of  the  organization 
under  simple  and  more  or  less  figurative  captions. 

Whence  the  Clinic  Children  Come  and  Whither 
They  Go. — If,  through  his  dramatic  sense,  the  imagination 
of  the  reader  has  been  caught  with  the  human  side  of  the 

299 


300     THE  CONSERVATION  OF  THE  CHH.D 

clinic,  he  will  vaguely  have  seen  in  his  mind's  eye  a  pro- 
cession of  children  coming  from  unknown  sources,  pausing 
for  an  examination,  then  passing  on  to  other  unknown 
points  of  distribution.  If  his  imagination  has  been  kin- 
dled to  the  point  of  framing  an  inquiry  it  may  have  taken 
the  form  of  two  questions,  "  Whence  come  these  children?" 
and  ''Whither  do  they  go?"  These  questions,  whether 
formulated  by  the  reader  or  not,  succinctly  analyze  the 
sociological  relations  of  the  clinin  into  two  classes;  for  as 
a  social  organism  the  clinic  is  concerned  almost  wholly 
with  the  receiving,  sorting  and  disposing  of  children.  In 
receiving  it  makes  no  distinction  whatever.  It  makes  no  re- 
quirementinregard  to  sex,  color,  age,  character,  social  posi- 
tion or  previous  condition,  but  freely  receives  all  alike.  It 
examines  them  individually  and  distributes  them  again  to 
their  properly  appointed  places  according  to  mental  and 
moral  worth.  In  this  capacity,  as  we  have  already  said, 
the  Psychological  Clinic  stands  oreeminent  as  a  clearing 
house  for  children.  When  they  first  come  it  is  true  that 
some  classification  has  already  been  made,  for  they  come 
because  they  are  mental  or  moral  deviates.  By  its  exami- 
nation the  clinic  further  classifies  them  and  assigns  them 
according  to  their  needs.  In  this  process  many  different 
professions  and  many  institutions  are  directly  or  indi- 
rectly involved. 

First,  the  gathering,  filing,  and  correlating  of  data 
secured  from  these  examinations  immediately  relate  the 
Psychological  Clinic  to  the  scientific  side  of  psychology  in 
general  and  particularly  to  that  branch  called  abnormal 
psychology, — a  relationship  further  strengthened  by  the 
training  of  clinic  examiners,  teachers  for  backward  chil- 
dren and  social  workers. 

Secondly,  the  child  who  is  the  primary  factor  in  the 


SOCIOLOGK  AL  RELATIONS  301 

situation  relates  the  clinic  directly  to  a  multitude  of 
social  institutions,  all  of  which  would  l)c  enumerated  in 
answering  fully  the  two  questions  propounded  above: 
"Whence  come  the  children?"  and  "Whither  do  they 
go?"  To  the  first  question  we  will  now  turn,  and  by  ex- 
amples of  actual  cases  give  some  idea  of  the  wide  range  of 
institutions  with  which  the  clinic  comes  into  immediate 
contact  on  its  receiving  side. 

Beginning  in  a  large  and  general  way,  the  children  may  he 
said  to  come  not  only  from  toidely  separated  localities,  hut 
from  many  strata  of  society.  The  residential  districts,  as 
well  as  the  slums,  contribute  their  quota  of  cases.  The 
shabby,  pallid,  wizened  offspring  of  the  poorest  couple 
may  be  followed  by  the  clean,  neat,  well-clad  child  of 
parents  in  good  circumstances.  For  imbecility  is  not 
nearly  so  much  a  matter  of  environment  as  are  the  con- 
tagious or  infectious  diseases.  It  illustrates  powerfully 
and  peculiarly  the  "ills  which  flesh  is  heir  to."  Heredity, 
more  than  any  other  group  of  factors,  plays  the  dominant 
part  in  its  perpetuation.  Its  law  is  no  respecter  of  persons. 
It  holds  among  the  rich  and  cultured  and  the  poor  and 
ignorant  alike.  At  one  period  of  European  history,  so  it 
is  said,  every  wearer  of  the  purple  was  feeble-minded. 
Certainly  Nero,  Commodus  and  Elagabalus  were  imbe- 
ciles or  idiots.  Epilepsy,  so  often  associated  with  mental 
deficiency,  and  resembling  it  in  its  tendency  to  inheritance, 
claimed  some  of  the  most  noted  men  of  the  world,  among 
them  Napoleon,  Rousseau,  Mohammed,  St.  Paul  and 
Caesar,  Inheritance  may  indeed  be  modified  by  proper  treat- 
ment, training  and  surroundings,  but  the  life  of  over-stimu- 
lation led  by  the  middle  and  upper  social  classes  in  modem 
America  favors  the  continuation  of  feeble-mindedness 
almost  as  much  as  do  the  privations  of  the  lower  classes. 


302     THE  CONSERVATION  OF  THE  CHILD 

From  the  Upper  Classes. — An  illustration  of  those 
coming  from  the  better  classes  is  Case  40,  a  young  girl 
of  twelve  years  who  did  not  take  her  first  step  until  she 
was  eighteen  months  of  age,  and  did  not  talk  until  she 
was  three  years  of  age.  She  started  to  school  when  three 
years  old  and  continued  until  she  was  twelve,  during  which 
time  she  made  no  progress.  She  was  able  to  add  two  and 
two,  but  said  three  times  four  equals  six,  and  six  plus  two 
equals  four.  Her  spelling  was  on  a  par  with  her  arithmetic. 
She  could  spell  cat  and  dog,  but  spelled  mouse,  m-o-s-e. 
At  home  she  played  with  children  much  younger  than 
herself,  and  could  not  comb  her  own  hair.  She  ate  at  the 
table  with  the  rest  of  the  family.  Her  disposition  was 
ordinarily  good,  but  sometimes  she  grew  causelessly  irri- 
table. Her  two  talents,  not  unusual  with  those  of  her 
class,  were  an  ability  to  sing  and  a  good  memory  for  dis- 
connected facts. 

In  general  appearance  she  was  tall  and  very  thin,  with  a 
well-shaped  cranium,  good  features  and  well-formed  ears. 
The  bridge  of  her  nose  was  thick;  her  upper  lip  was  short; 
and  her  palate  narrow  and  V-shaped.  Her  skin  was  some- 
what rough  and  she  suffered  from  pediculosis  capitis  to 
such  an  extent  that  her  scalp  in  places  had  been  scratched 
raw  with  her  finger  nails  in  a  vain  endeavor  to  find  some 
relief  from  the  pests. 

Surprising  as  it  may  seem,  this  child  came  from  a  good 
family.  The  mother  was  elegantly  and  fashionably 
dressed  and  presented  every  mark  of  good  social  position 
and  some  culture.  The  father  was  a  business  man  in  an 
eastern  city.  Yet  the  child  was  feeble-minded  and  not 
above  the  rank  of  the  middle-grade  imbecile. 

Though  she  is  not  an  isolated  case  by  any  means,  it 
must  be  said  that  the  clinic  does  not  receive  the  majority 


SOCIOLOGICAL  RELATIONS  SOS 

of  its  cases  from  her  class.  This  is  readily  explained,  not 
by  the  infrequency  of  feeblc-mindedness  among  the  upper 
classes,  but  by  their  financial  ability  to  pay  for  private 
examinations  and  private  instruction  of  their  mentally 
defective  children,  and  also,  as  remarked  by  Dr.  Tredgold 
and  Dr.  Witmer,  to  the  sheltered  position  of  many  rich 
men's  sons  and  daughters,  who,  by  reason  of  their  power 
to  hire  things  done,  naturally  frame  for  themselves  an 
environment  so  simple  that  it  never  overtaxes,  and  hence 
never  reveals  their  congenitally  limited  capacities. 

From  the  Lower  Classes. — The  other  social  extreme 
is  well  represented  in  our  files.  A  striking  illustration  is 
a  girl  from  a  family  of  seven  children,  or  rather  the  re- 
mainder of  the  seven,  who  live  in  conditions  of  squalor 
and  disease  hardly  conceivable  to  people  of  easy  circum- 
stances. 

Case  89  was  the  daughter  of  a  ragpicker,  the  flower  of 
a  flock  of  seven  children  of  whom  two  had  died,  one  as  a 
result  of  accident,  and  one  from  pneumonia.  Of  the 
remaining  five  children,  the  oldest  boy  was  a  low-grade 
imbecile,  through  whom  the  clinic  came  in  touch  with 
the  family.  The  second  boy  was  a  frail-looking  child, 
backward  in  his  school  work.  The  social  worker  who 
visited  the  home  and  the  school  found  this  boy  one  of  a 
large  group  of  desperately  poor  foreigners,  who  were  being 
taught  in  a  public  school-room  entirely  without  ventilation. 
At  home  one  of  the  younger  children  was  apparently  in 
very  poor  physical  condition,  and  was  said  to  be  afflicted 
with  tuberculosis.  A  baby  had  been  for  some  time  in  the 
hospital,  where  he  was  treated  with  thyroid  extract  for 
cretinism.  In  addition  to  insufficient  nutrition  and  lack 
of  care,  both  the  result  of  poverty  in  its  most  vicious  and 
degraded  form,  some  marked  cause  of  degeneracy  in  the 


304     THE  CONSERVATION  OF  THE  CHILD 

family,  possibly  syphilis,  had  cast  its  perpetual  blight 
over  at  least  two  of  the  children,  one  of  them  the  girl  here 
described. 

She  first  came  with  her  elder  brother,  in  1910,  to  the 
Psychological  Clinic,  accompanying  him  and  the  mother 
because  no  one  was  at  home  with  whom  she  could  be  left. 
In  spite  of  the  fact  that  the  child,  poorly  clad  and  unpro- 
tected from  the  weather,  had  come  some  distance  in  the 
rain  she  presented  an  exceedingly  attractive  appearance, 
with  her  Latin  type  of  beauty,  her  small  stature  and  lov- 
able face,  made  more  striking  by  their  setting  of  squalor. 
Mentally  she  appeared  to  be  normal  except  for  a  retarda- 
tion easily  explained  by  home  conditions  and  physical 
defects.  Her  teeth  were  in  a  wretched  state;  she  suffered 
from  pediculosis;  a  bad  cough  suggested  tuberculosis,  and 
the  naso-pharynx  was  obstructed  with  adenoids  and 
enlarged  tonsils.  Although  she  was  mentally  normal,  her 
physical  condition  was  such  that  the  clinic  took  her  in 
charge  to  administer  the  care  and  training  required  to 
save  her  from  future  mental  and  moral  deterioration. 

During  a  period  of  two  months  she  was  taken  for  regular 
treatment  to  the  Dental  Clinic  of  the  University  of  Penn- 
sylvania, and  also  placed  under  the  direction  of  a  specialist 
for  anti-syphilitic  treatment.  So  far,  however,  had  the 
physical  deterioration  progressed  that  at  seven  years  of 
age  it  was  already  too  late  to  free  her  entirely  from  the 
degenerating  effects  of  her  environment;  and  yet,  if  this 
little  girl  could  have  been  kept  for  six  months  or  a  year  in 
a  favorable  environment,  and  subjected  to  satisfactory 
educational  influences,  it  might  have  been  possible  to 
arrest  the  progress  of  physical  degeneracy  and  to  over- 
come moral  and  mental  retardation. 

Many  other  cases  might  be  chosen  to  illustrate  the 


SOCIOLCXJK^AL  RELATIONS  305 

service  performed  by  the  clinic  for  needy  memljers  of 
society,  but  space  will  not  permit  the  citation  of  more 
than  one  other,  valuable  as  a  specific  instance  of  private 
philanthropy  finding  expression  through  the  ready  oppor- 
tunity offered  l)y  the  clinic. 

Another  example  of  destitution,  almost  equal  to  the 
case  cited  above,  was  exhibited  by  Case  58,  brought 
to  the  clinic  October  9,  1909,  by  a  public  school 

1  •  1      1    •!        •       1  -^  Slum    Boy 

teacher  who  was  mterrupted  daily  m  her  work 
by  a  noise  from  the  street  corner  like  that  of  a  miniature 
boiler  shop.  Upon  investigation  it  turned  out  to  be  one 
small,  lone  urchin  assiduously  drumming — to  him — sweet 
music  from  a  trolley  pole.  Further  investigation  proved 
this  to  be  his  chief,  if  not  onlj'',  recreation.  At  his  home — 
two  poor  rooms  in  a  tenement — eight  other  children  (left 
from  a  flock  of  thirteen)  demanded  all  the  scant  space 
available  and  all  the  care  the  busy  mother  could  give.  J. 
had  to  find  an  outlet  for  his  energies  upon  the  street  and 
manufacture  amusement  out  of  trolley  poles. 

Though  he  was  eight  years  old,  his  apparently  hopeless 
stupidity,  reported  as  "idiocy"  and  "gross  mental  defi- 
ciency," combined  with  disorderliness  and  intractability, 
had  precluded  his  admission  to  the  public  school  and 
caused  him  to  be  rejected  by  the  neighboring  parochial 
school.  His  education,  as  well  as  his  recreation,  had  been 
obtained  on  the  street. 

The  teacher,  touched  by  the  forlorn  child  and  the  desti- 
tution of  his  home,  undertook  to  do  something  for  him. 
His  mental  state  suggested  the  Psychological  Clinic  at  the 
University  of  Pennsylvania,  and  with  the  parents'  consent 
he  was  brought  for  a  careful  jihysical  and  mental  examina- 
tion. He  was  undersized  and  miderweight,  stooping 
forward  like  an  old  man,  and  moving  slowly  and  feebly. 
20 


306     THE  CONSERVATION  OF  THE  CHILD 

Some  of  his  teeth  were  lacking,  others  were  decayed,  and 
he  was  very  deaf.  His  nose  discharged  continually,  and 
his  open  mouth  and  nasal  deformity  indicated  adenoids. 
Tickling  the  boy  brought  only  a  whimper.  While  at  the 
clinic  he  did  not  smile  once,  and  spoke  but  one  word, 
and  that  was,  "candy."  He  could  not  wash  nor  dress 
himself;  did  not  know  colors,  nor  the  names  of  many 
common  objects;  spoke  only  in  monosyllables,  and  of 
course  could  neither  read  nor  write.  He  showed  no  affec- 
tion, received  candy  and  peanuts  without  a  word  or  a  look 
of  thanks;  held  on  to  them  and  to  his  cap  as  though  he 
expected  some  one  to  snatch  them  away,  and  continually 
exhibited  a  covert  animal  watchfulness  for  the  moment 
when  he  might  escape. 

On  the  same  day  he  was  taken  to  the  Nose  and  Throat 
Dispensary  of  the  University  of  Pennsylvania,  where 
adenoids  were  diagnosed.  Three  days  later,  the  boy  was 
operated  upon  at  the  University  Hospital  and  a  large 
adenoid  removed.  When  he  appeared  at  the  Psycho- 
logical Clinic  on  the  fourth  day  following  the  operation, 
he  was  brought  in  by  the  teacher,  assisted  by  our  social 
worker,  only  after  strenuous  coaxing.  To  his  natural 
timidity,  almost  that  of  a  young  savage,  had  been  added 
the  fear  of  the  clinic,  bred  of  his  experience  in  the  necessary 
examination  of  his  nose  and  throat.  But  his  improvement 
was  instantly  remarked.  He  breathed  better  and  the 
nasal  discharge  had  ceased.  It  could  now  be  determined 
that  he  was  able  to  hear  in  one  ear,  and,  most  encouraging 
of  all,  he  spoke  a  few  words.  A  week  later  he  even  smiled. 
He  also  played  with  the  toys,  called  many  of  them  by 
name,  learned  to  string  beads,  and  after  repeated  instruc- 
tion was  finally  able  to  select  and  string  yellow  ones.  He 
was  comparatively  responsive,  inquisitive,  and  showed  an 


SOCIOLOGICAL  RELATIONS  307 

unusual  energy  for  doing  things.  He  reacted  to  some  of 
our  tests  as  docs  a  feeble-minded  child. 

At  the  end  of  another  week  he  showed  increased  im- 
provement. The  social  worker,  who  visited  his  home  to 
assist  the  family  with  instruction  and  a  gift  of  some 
clothing,  reported  that  he  had  astonished  his  mother  one 
day  this  week  by  using  for  the  first  time  in  his  life  two  or 
three  words  together.  This  first  sentence  was,  "Mom,  my 
shoe  hurts  me."  He  had  ceased  the  screaming  in  the 
street  as  well  as  the  hammering  on  trolley  poles  which 
annoyed  the  neighbors  so  much,  and  had  become  more 
tractable  in  the  house.  The  "viciousness"  of  which  the 
mother  had  complained,  such  as  pulling  his  brothers'  hair, 
spitting  in  their  faces,  lighting  matches  and  setting  fire 
to  paper  in  the  house,  had  not  shown  itself  since  the 
operation.  He  was  plajdng  or  working,  whichever  we 
choose  to  call  it,  in  a  more  sensible  and  intelligent  manner. 
He  had  a  craze  to  use  hammer  and  nails  and  succeeded 
one  morning  in  driving  nails  into  the  front  door  so  that 
it  was  impossible  to  get  it  open.  The  social  worker  sug- 
gested to  the  mother  to  give  the  boy  a  block  of  wood  and 
some  nails,  and  let  him  amuse  himself. 

When  provided  in  this  way  with  occupation  he  was  good 
for  hours.  However,  there  was  no  school  nor  kindergarten 
of  any  kind  in  the  neighborhood  where  he  could  be  entered ; 
so  the  boy  was  finally  placed  by  a  charitable  organization 
in  an  institution  for  feeble-minded  children,  where  he  is 
at  the  present  time. 

Cases  from  the  Home. — Passing  now  from  the  general 
sources  represented  by  the  social  grades  from  which  chil- 
dren come,  we  proceed  to  those  more  specific  sources 
represented  by  the  multitude  of  institutions  in  which 
children  are  found.     It  must  be  remembered  that  the 


308     THE  CONSERVATION  OF  THE  CHHJ) 

clinic  in  its  capacity  of  receiving  and  dealing  with  all 
classes  of  special  children,  supernormal  or  subnormal, 
extends  its  helpful  services  just  as  far  as  the  world  of 
needy  childhood  extends.  First  and  chief  among  these 
realms  is  the  home;  and  from  the  home,  therefore,  most 
of  the  cases  come.  Often  the  advice  of  the  school-teacher, 
a  newspaper  notice,  or  the  word  of  a  good  neighbor,  is  the 
immediate  occasion  of  informing  and  moving  the  parent 
to  bring  the  child.  The  cause  is  either  a  long  series  of 
transgressions  slowly  but  continually  growing  worse  as 
effort  after  effort  on  the  part  of  the  parent  fails  to  reform 
the  bad  boy  or  girl;  or  again  it  may  be  a  gradual  falling 
behind  in  the  grades  at  school;  until  finally  the  clinic  is 
called  upon  to  locate  the  cause,  and  if  possible  to  remove  it. 

Case  151  was  a  girl  four  and  one-half  years  of  age, 
who  was  brought  to  the  clinic  by  her  mother  in  February, 
1910,  because  she  did  not  talk. 

When  she  was  one  year  old  she  had  grippe  very  badly 
and  nearly  died.  When  two  years  old,  just  as  she  had 
A  Speech  begun  to  say  a  few  words,  she  contracted  and 
^*^®  developed  a  severe  case  of  measles.    When  she 

recovered  she  retained  the  few  words  she  had  already 
acquired,  but  did  not  learn  any  more.  In  other  respects 
she  was  only  slightly  retarded.  The  first  tooth  came  at 
about  eight  months,  and  when  two  years  old  she  began 
to  walk. 

The  conditions  of  birth  were  normal.  In  the  family 
history  the  only  factor  of  importance  developed  was  the 
statement  that  the  father  was  tongue-tied  when  a  child. 

The  physical  examination  revealed  no  important  con- 
genital anomalies.  The  left  eye  is  a  little  higher  than  the 
right.  At  the  time  of  the  examination  the  family  ph3^sician 
stated  that  she  appeared  to  be  in  good  physical  condition, 


SOCIOLOGICAL  RELATIONS  309 

except  that  her  left  tonsil  was  much  swollen  and  her 
adenoids  were  probably  liypertropliied.  Her  nose  was 
undeveloped  at  the  base;  the  nostrils  were  small;  the  upper 
lip  overhung  the  lower.  Two  adenoid  growths  had  been 
previously  removed. 

The  mental  examination  revealed  no  other  defects  than 
those  concomitant  with  her  speech  retardation.  Her 
mother  reported  her  an  obedient  and  affectionate  ciiild, 
now  becoming  sensitive  over  her  inability  to  talk,  seeking 
quietness  and  liking  to  be  by  herself.  The  girl  could  give 
the  soft  sound  of  "t"  and  "p";  the  hard  sound  of  "b" 
and  "d",  and  the  "th"  and  "f"  sounds,  but  said  "cha" 
for  "k,"  "m"  for  ''y;"  gave  a  sort  of  a  "dh"  sound  for 
"g,"  "pee"  for  "bee,"  "tee"  for  "dee"  "sh"  for  "s," 
"fee"  for  "o,"  "ou"  for  "r."  She  could  utter  "at" 
quite  distinctly,  said  "mama"  and  "papa"  and  tried  to 
say  'thank  you"  and  "please." 

On  March  9,  1910,  she  was  entered  in  the  speech  class 
at  the  clinic  and  was  progressing  rapidly  when  the  term 
ended  on  ]\Iay  23,  1910.  She  was  to  return  in  the  fall,  but 
when  again  brought  to  the  clinic  by  her  mother  she  was 
found  to  be  so  well  started  in  correct  speech  habits  and  had 
made  such  progress  that  it  was  not  thought  necessary  to 
give  her  any  further  training  here,  for  it  appeared  certain 
that  she  would  acquire  language  in  the  normal  way. 

Case  83  was  a  boy  eight  years  old  who  had  been  reared 
in  England,  where  his  grandfather  and  uncles,  men  of  good 
family  and  comfortable  circumstances,  made  him  the  pet 
and  idol  of  the  home.  There,  in  a  small  town,  ho  spent 
his  early  years  and  went  to  school,  passhig  his  holidays 
with  his  grandfather  or  uncles  on  the  river. 

In  the  meantime,  on  account  of  business,  his  father 
found  it  necessary  to  si)end  a  great  deal  of  his  time  in 


310     THE  CONSERVATION  OF  THE  CHILD 

America,  so  that  father  and  son  were  practically  unac- 
quainted. Finally,  it  was  decided  it  would  be  best  for  the 
boy  and  his  mother  to  join  the  father  in  this  country. 
A  Trans-  As  E  posult  the  boy  was  suddenly  removed  from 
Case  the  environment  to  which  he  was  accustomed  and 

throwai  into  totally  new  surroundings.  He  was  sent  to 
the  regular  public  school  and  put  in  the  first  grade.  The 
work  was  of  course  quite  different  from  that  of  the  English 
school  and  he  was  not  promoted  to  the  second  grade  at 
the  end  of  the  term.  His  conduct,  however,  in  the  school- 
room was  very  good  and  the  teacher  had  no  fault  to  find 
with  him  in  that  direction.  Out  of  school  hours  he  spent 
most  of  his  time  with  his  mother  at  home  until  a  second 
child  was  born  in  the  family.  Just  before  and  after  the 
birth  of  this  child  the  boy  was  thrown  on  his  own  resources 
and  not  unnaturally  drifted  into  bad  companionship. 
This  was  du3  to  the  fact  that  he  was  in  a  strange  land  and 
was  unskilled  in  the  games  of  the  American  youths.  Not 
readily  acceptable  to  boys  of  his  own  class,  he  found 
refuge  in  a  crowd  of  "older  fellows,"  who  made  him  their 
tool.  In  order  to  maintain  his  place  with  them,  and  proba- 
bly, too,  on  account  of  their  threats,  he  began  taking 
money  from  home.  On  one  occasion  he  took  fifteen  dollars, 
and  on  another  thirty-five.  At  other  times  his  pilfering 
was  limited  to  small  sums,  with  which  he  bought  candy  for 
the  older  boys.  As  might  be  expected,  when  questioned 
about  the  money  he  lied.  For  fear  of  i^unishment  at  home, 
he  often  stayed  out  late  at  night.  He  also  played  truant 
as  often  as  four  times  in  one  week. 

To  account  for  these  tendencies  toward  evil  no  causes 
could  be  found  in  the  family  history.  The  boy's  birth  had 
been  an  instrumental  delivery;  his  health  had  been  fairly 
good  up  until  four  months  previous  to  the  examination. 


SOCIOLOGICAL  RELATIONS  311 

when  ho  was  attacked  by  a  "kind  of  .spoil"  and  became 
unconsciou.s.  Later  he  was  overtaken  by  a  ^<imilar  spell, 
which  a  physician  diagnosed  as  convulsions,  jjrobably  due 
to  indigestion. 

In  appearance,  though  small,  this  boy  was  well  formetl; 
and,  excepting  that  he  had  adenoids,  was  ^\^thout  physical 
defect.  He  was  bright,  pleasant  faced,  very  well  mannered, 
quiet  spoken,  and  altogether  presented  th(i  appearance  of 
a  most  charming  and  lovable  boy. 

After  the  removal  of  the  adenoids,  it  was  reported  by 
his  mother  that  there  was  a  marked  change  in  her  son 
and  that  he  was  "just  as  good  as  he  had  been  before  any 
trouble  arose."  Very  probably,  however,  the  chief  cause 
of  the  boy's  bad  conduct  lay  in  his  environment.  His 
natural  craving  for  the  company  of  boys  led  him  to  take 
any  means  to  attain  it.  Money  was  to  him  as  nothing. 
The  fact  that  he  took  large  sums  was  due  altogether  to 
the  fact  that  these  sums  lay  in  his  way.  He  may  have 
had  a  vague  notion  that  it  was  wrong,  ])ut  how  ^v^ong 
was  altogether  bej'ond  his  comprehension.  His  truancy 
and  staying  out  at  night  were  probably  due  to  the  punish- 
ments he  received  for  his  first  misdemeanors.  The  removal 
of  the  adenoids  eliminated  one  source  of  irritation,  but 
added  to  this  was  the  clearer  understanding  of  the  child, 
acquired  by  the  parents  through  the  advice  and  informa- 
tion given  by  the  clinic,  coupled  with  their  desire  to  do  the 
very  best  for  their  boy.  Their  attitude  toward  him  was 
changed  and  as  a  consetiuence  his  conduct  was  altered. 
Unnatural  as  it  may  sound,  he  and  his  father  became  ac- 
quainted and  the  boy,  first  so  petted  by  his  relatives  across 
the  sea,  then  lioreft  of  all  suitable  companionship  and  left  to 
find  what  entertaimnent  he  might  in  the  streets,  began  now 
to  receive  from  his  parents  the  attention  he  naturally 


312     THE  CONSERVATION  OF  THE  CHILD 

craved.  Outdoors  upon  the  streets  and  in  school  he  grad- 
ually became  adapted  to  the  ways  of  American  boys  and 
eventually  found  new  and  wholesome  modes  of  expres- 
sion for  his  juvenile  desires. 

Case  94  is  a  boy  eleven  years  of  age  who  was  brought 
to  the  clinic  in  November,  1909,  by  his  mother,  on  account 
Simple  o^  retardation.  He  had  been  at  school  five  years 
Retardation  ^^^  j^jg  ^j^j^f  pedagogical  troublc  seemed  to  be 
extreme  backwardness  in  reading.  He  tried  to  study  at 
home,  but  efforts  and  results  were  alike  unsatisfactory. 

C.'s  family  consisted  of  father,  mother  and  four  children, 
three  others  having  died  in  infancy  of  diphtheria.  The 
eldest  boy  was  twenty-one  years  old,  and  of  nervous  tem- 
perament. C.'s  birth  was  natural,  his  mother,  a  Scotch 
woman,  being  well  and  robust.  The  father  appeared 
physically  well,  but  had  been  inclined  to  melancholia  since 
he  had  lost  his  three  children.  Several  members  of  his 
family  had  gone  insane.  C.  walked  and  talked  at  the  usual 
age  and  suffered  no  serious  illness  except  moderate  attacks 
of  measles  and  whooping-cough.  He  had,  however,  a  hernia 
in  his  left  groin,  to  which  a  truss  had  been  recently  fitted. 
The  physical  examination  showed  also  a  decided  curva- 
ture of  the  spine;  long  head,  narrowing  to  the  front;  fore- 
head of  medium  height;  nose  broad  at  the  bridge,  nostrils 
small,  septum  deflected  to  the  left;  mouth  open  much  of 
the  time;  upper  lip  short,  lower  lip  corrugated  and  hanging 
down;  teeth  black  and  ill-cared  for,  with  tartar  pushing 
back  the  gums;  heart  action  decidedly  irritable,  lungs 
normal;  cervical  and  post-cervical  glands  decidedly  large. 
The  boy  was  round  shouldered,  with  infantile  protuberance 
of  the  abdomen. 

The  mental  examination  showed  that  he  was  obedient, 
affectionate,  generous,  and  thoughtful;  loved  pets;  had  no 


SOCIOLOGICAL  RELATIONS  313 

bad  habits;  active  when  not  in  school,  as  he  delivered 
bread  for  a  baker  in  the  neighborhood  of  his  home.  He 
Hked  tools  and  had  tried  his  hand  at  carp(uitry.  He  did 
fairly  well  in  arithmetic;  his  reading  was  wholly  unsatis- 
factory, though  he  endeavored  to  tell  the  story  of  what  he 
had  read  with  some  intelligence.  He  also  knew  colors 
well. 

He  was  operated  on  for  the  removal  of  adenoids  and 
tonsils.  He  was  also  sent  to  the  Eye  Clinic,  whore  he 
received  treatment  and  was  fitted  with  glasses.  The 
operation  for  adenoids  and  tonsils  and  the  relief  which 
the  glasses  brought  marked  a  decided  improvement  in 
the  boy's  condition.  He  was  then  taken  to  the  Dental 
Clinic,  where  he  had  his  teeth  properly  adjusted. 

C.  then  returned  to  school  and  his  teacher  reported 
progress  to  the  extent  that  she  expected  to  promote  him 
in  June. 

On  July  5,  1910,  he  entered  the  summer  school.  Here 
he  was  back  in  his  work,  in  fact  far  below  the  other  boys 
of  his  age.  He  made  his  greatest  improvement  in  arith- 
metic and  reading.  In  the  class  he  did  fairly  well  in 
history,  but  he  said  that  he  could  not  answer  any  of  the 
questions  given  him  in  the  test.  He  did  a  great  deal  of 
talking  at  first  with  the  boys  near  him,  but  gradually 
calmed  down  and  became  one  of  the  best  boys  in  the 
school.  Occasionally  he  showed  his  temper,  but  a  few 
words  of  caution  about  boys  who  lose  their  tempers  set 
him  to  rights.  He  was  active  in  the  swimming  pool  and 
gymnasium,  making  great  progress  in  the  latter  and 
developing  into  one  of  the  quickest  boys  on  the  floor. 

On  October  13,  1910,  his  mother  reported  that  he  was 
doing  exceedingly  well  at  school;  that  he  had  enjoyed  the 
summer  school  and  talked  a  great  deal  about  it.     She 


314     THE  CONSERVATION  OF  THE  CHILD 

thinks  he  has  greatly  improved  since  going  there.  On 
November  1,  1910,  it  was  reported  that  he  had  been 
promoted  into  the  third  grade,  and  on  February  13,  1911, 
his  mother  sent  word  that  he  had  been  advanced  to  the 
succeeding  grade. 

Next  to  those  brought  from  home,  by  Jar  the  largest  number 
of  children  come  from  the  public  and  parochial  schools. 
Very  frequently  it  happens  that  a  public  school  teacher 
observes  a  pupil  who  is  dull  below  the  average.  She  may 
even  suspect  a  case  of  imbecility ,  but  discretion  prevents  her 
from  stating  her  suspicion  to  the  naturally  opinionated 
parents.  She  therefore  refers  them  to  the  clinic  with  the 
statement,  "John  is  backward  in  his  studies  and  had  better 
be  examined  at  the  University."  By  such  a  course,  the 
teacher  avoids  all  possible  controversy  and  puts  the  case 
into  the  hands  of  experts  in  whom  the  parents  have 
abundant  confidence.  As  a  result,  the  teacher  is  relieved 
from  irritating  and  hopeless  efforts  to  teach  a  pupil  in 
the  presence  of  unnecessary  obstacles;  the  parents  are 
given  a  better  notion  of  their  responsibilities;  the  child 
is  freed  from  useless  nagging  and  punishment,  and  given 
positive  aid;  and  finally  a  greater  spirit  of  cooperation  is 
cultivated  between  the  school  and  the  home. 

Case  81  was  a  boy  nine  years  of  age  who  was  referred 
to  the  clinic  on  November  10,  1909,  by  the  principal  of 
Incurable  ^  public  school  bccausc  of  general  backwardness. 
Retardation  ^^g^  fivc  ycars  old  he  started  kindergarten 
work  and  afterwards  went  to  public  school,  where  he  made 
no  progress.  He  was  promoted  from  the  first  grade  into 
the  second  grade  A  without  his  letters.  The  case  was 
greatly  complicated  by  bad  conduct  on  the  boy's  part 
and  by  the  alcoholic  intemperance  of  both  his  father  and 
mother.    The  cause  of  his  trouble  was  a  fall  which  he  had 


SOCIOLOGICAL  RELATIONS  315 

when  about  four  and  one-half  years  of  age  and  which  left 
a  scar  and  lump  in  the  middle  of  his  forehead.  About  two 
weeks  Inter  he  fell  again  from  the  same  steps,  this  time 
striking  upon  the  back  of  his  head  with  such  force  that 
he  had  to  be  taken  to  the  Children's  Hospital,  and  for 
two  or  three  months  after  he  was  unable  to  use  his  limbs. 
His  left  side  was  more  affected  than  the  right  and  when 
he  finally  began  to  walk  again  he  dragged  his  left  foot. 
Since  the  fall  he  had  suffered  from  severe  headaches,  was 
extremely  nervous,  and  for  this  affection  had  been  taken 
to  a  hospital. 

He  was  somewhat  under  normal  stature  for  his  age  and 
not  well  nourished.  Both  eyes  were  somewhat  under- 
developed and  his  right  eye  was  a  little  larger  than  the 
left.  His  left  shoulder  was  lower  than  the  right  and  he 
was  stooped  forward. 

The  mental  examination  revealed  a  low  degree  of 
mentality.  He  could  distinguish  colors,  but  he  did  not 
know  how  to  read  the  simplest  words  nor  even  to  call  the 
letters.  His  father  had  undertaken  to  teach  him  his 
letters,  but,  though  lie  would  apparently  learn  them  in  the 
evening,  he  would  invariably  forget  them  by  the  next 
morning.  His  counting  was  equally  primitive.  He  knew 
that  a  nickel  was  equal  to  five  pennies,  but  failed  on  other 
coins. 

Two  weeks  after  the  examination  he  underwent  an 
operation  for  adenoids.  Two  months  later  the  principal 
put  him  back  into  the  first  grade,  for  although  he  had 
improved  somewhat,  he  was  not  at  all  fit  to  be  in  the 
second  grade. 

A  month  later  she  reported  that  he  had  been  greatly 
improved  physically  by  the  treatment,  but  was  not 
progressing  in  his  school  work  as  he  should.    A  little  later 


816     THE  CONSERVATION  OF  THE  CHH.D 

the  boy  stole  twenty  dollars  from  a  coal  office,  but  his 
arrest  was  deferred  and  the  case  eventually  dropped  when 
he  returned  all  but  forty-three  cents  which  he  had  spent 
for  boyish  trifles.  In  the  meantime  the  boy's  home  suffered 
many  vicissitudes  due  to  his  mother's  alcoholic  intemper- 
ance, her  frequent  absences  from  home  and  one  attempt 
at  taking  her  own  life  by  poison.  As  a  result  of  such  con- 
ditions, no  help  could  })e  looked  for  from  that  direction 
and  after  he  had  remained  in  one  grade  in  the  public 
school  for  five  years,  his  parents  were  persuaded  to  con- 
sent to  do  whac  should  have  been  done  at  first,  namely, 
to  place  the  boy  in  an  institution  for  feeble-minded  chil- 
dren. It  was  due  to  the  acquaintance  of  a  school  principal 
with  the  clinic  that  the  right  course  was  finally  advised. 

Case  93  is  a  girl  nine  years  of  age  who  was  brought  to 
the  clinic  in  March,  1907,  by  a  school  nurse,  the  child 
having  been  three  years  in  the  first  grade  without  making 
any  progress.  She  could  read  a  few  figures,  but  was  unable 
to  make  them.  At  two  years  of  age,  when  commencing 
to  walk,  she  fell  into  the  cellar  and  immediately  after- 
wards began  having  fits.  She  was  taken  to  the  Orthopedic 
Hospital,  where  they  recommended  the  removal  of  her 
tonsils.  At  first  these  fits  came  on  aljout  every  three 
months,  either  day  or  night,  but  in  the  last  two  years  she 
had  not  had  bad  attacks. 

The  physical  examination  confirmed  the  diagnosis  made 
at  the  Orthopedic  Hospital  of  enlarged  tonsils  and  ade- 
An  institu-  Hoids.  On  April  13, 1907,  the  child  was  operated 
tion  Case  ^^  j^y  j^j,  Packard,  who  took  out  the  tonsils 
and  scraped  the  naso-pharyngeal  vault.  After  the  opera- 
tion the  nurse  reported  that  the  child  was  much  improved, 
and  the  mother  said  that  during  the  week  after  the  opera- 
tion she  noticed  for  the  first  time  that  the  child  took  an 


SOCIOLOGICAL  RELATIONS  317 

interest  in  herself  and  worked  about  the  house.  She 
looked  much  brighter,  and  talked  more  freely,  and  there 
was  nothing  in  her  manner  to  suggest  mental  deficiency. 

However,  on  November  22,  1909,  she  was  again  brought 
to  the  clinic  by  her  mother,  who  stated  that  she  would 
not  go  to  school  regularly.  Sometimes  she  appeared  at 
school  an  hour  late,  again  she  would  become  so  absorbed 
in  the  store  windows  that  she  forgot  entirely  where  she 
was  going.  After  examining  the  case  and  reading  over 
the  past  history,  it  was  decided  that  the  diagnosis  of 
epilepsy  could  be  made  with  a  fair  degree  of  certainty. 

On  November  29,  1909,  she  was  again  brought  to  the 
clinic  by  the  probation  officer,  who  stated  that  she  had 
visited  the  home  and  found  it  in  a  wretched  condition, 
frightfully  dirty  and  without  water.  December  6,  1909, 
L.  was  again  brought  to  the  clinic  by  the  probation  officer, 
who  reported  that  water  had  been  put  in  the  house  and 
that  L.  showed  the  good  effects  of  this.  Finally,  on 
January  6,  1911,  she  was  sent  to  the  Colony  Farm  and 
Epileptic  Home  at  Oakburne,  Pa.,  and  on  February  1, 
1911,  it  was  reported  that  she  was  doing  well  in  that 
institution. 

Many  children  are  sent  from  charitable  organizations.  To 
these  societies  the  clinic  is  proving  itself  an  invaluable 
aid.  As  social  workers  recognize  more  and  more  that 
delinquent  children  are  not  all  bad  through  their  own. 
volition  nor  all  of  them  bad  through  e.xternal  environment, 
but  some  of  them  through  incurable  affections  demanding 
most  skilful  tests  to  discover,  they  turn  readily  to  the 
clinic  for  aid  in  deciding  the  disposal  of  such  charges. 
By  having  defects  discovered  and  the  remedy  applied 
before  any  attempt  is  made  to  locate  the  charge  perma- 
nently, manj-  children  are  saved  from  useless  and  perni- 


318     THE  CONSERVATION  OF  THE  CHILD 

cious  transfers  from  institution  to  institution,  and  family 
to  family,  and  the  charitable  organization  is  not  only 
relieved  from  much  worry  and  useless  work  but  is  per- 
mitted to  extend  its  efforts  to  many  other  needy  objects. 
This  course  frequently  entails  medical  and  surgical  relief, 
followed  by  a  course  of  constitutional  treatment  or  moral 
training  in  some  appropriate  home  or  institution.  As  an 
example  of  what  can  be  done  in  this  field,  the  following  case 
is  offered. 

Case  152  was  a  boy  thirteen  years  of  age  brought  to 
the  clinic,  February,  1910,  by  a  probation  officer,  for 
backwardness  in  school,  stealing  and  begging.  He  was 
not  a  court  boy,  but  the  probation  officer  having  his 
brother  in  charge  became  interested  in  him.  She  stated 
that  he  had  been  arrested  two  times  for  begging  on  the 
streets,  where  he  pleaded  for  money  to  bury  an  imaginary 
sister. 

He  commenced  kindergarten  work  when  four  and  one- 
half  years  old  and  entered  pubUc  school  a  year  and  a 
A  Proba-  half  later,  where  he  remained  three  years  in  one 
tionCase  grade.  He  then  went  to  a  parochial  school, 
staying  there  nearly  five  years,  and  again  entered  the 
public  school.  He  could  not  do  the  work  of  the  fourth 
grade  and  was  placed  in  the  third  grade  B. 

When  about  two  years  old  he  had  eczema,  from  which 
he  continued  to  suffer  until  he  was  seven  years  old.  During 
that  time  he  had  an  abscess  on  his  neck  which  asted  a 
year,  and  which  was  followed  by  many  abscesses  and 
boils.  He  had  the  measles,  whooping-cough,  chicken-pox 
and  bronchitis,  from  which  he  lost  his  voice  for  a  time.  He 
began  to  walk  when  about  seventeen  months  old,  and  his 
talking  and  teething  were  slower  than  the  other  children 
in  the  family. 


SOCIOLOGICAL  RELATIONS  319 

One  of  his  Ijrothors,  twonty  years  of  ago,  had  been  in 
the  House  of  Refuge  and  the  Rahway  Reformatory,  and 
was  away  from  home.  Another  brother,  aged  fifteen  years, 
was  on  probation,  facing  the  probabihty  of  also  entering 
the  House  of  Refuge.  M.  himself  had  been  in  an  Industrial 
School,  and  when  ten  years  old  had  run  away  and  remained 
away  from  home  for  three  years  under  an  assumed  name. 

In  general  manner  he  was  apathetic  with  a  rather  expres- 
sionless face.  In  walking  his  entire  right  side  drooped; 
a  prominent  protuberance  appeared  in  the  occipital  region 
of  his  skull  and  a  slight  prominence  in  the  left  frontal 
region;  his  hearing  was  very  slightly  impaired  in  the  right 
ear;  his  tonsils  were  enlarged  and  indications  of  adenoids 
visible. 

The  mental  examination  showed  that  he  could  do  simple 
addition  and  subtraction  of  fractions  correctly,  but  failed 
in  multiplication.  He  could  read  from  the  fifth  reader 
fairly  well;  he  also  read  from  the  sixth  reader,  although 
he  did  not  understand  the  meaning  of  many  words  and 
pronounced  many  incorrectly.  The  boy  admitted  that 
he  was  in  the  habit  of  steahng,  but  that  he  stole  nothing 
but  pencils,  which  he  often  gave  away.  The  probation 
officer  said  it  was  very  likely  that  he  did  give  them  away, 
as  he  was  a  generous,  good-natured  boy.  However, 
according  to  her  statement,  the  boy  took  other  things 
besides  pencils.  The  Mother  Superior  of  the  parochial 
school  which  he  attended  stated  that  he  was  disobedient, 
but  a  great  coward.  She  was  always  able  to  get  the  truth 
from  him  by  telling  him  that  if  he  did  not  tell  the  truth 
she  would  turn  him  over  to  an  officer. 

He  was  sent  to  the  eye  and  ear  clinics  and  also  operated 
upon  for  the  removal  of  adenoids.  On  July  5,  1910,  he 
entered  the  summer  school  with  every  great  promise  (if 


320     THE  CONSERVATION  OF  THE  CHILD 

his  o\\'Ti  word  was  to  be  taken  for  it)  of  working  a  real 
self-reformation.  But  his  slinking  movements  and  his 
sneaking  manner  soon  attracted  the  attention  of  the  other 
boys  in  the  class.  They  did  not  take  kindly  to  him  and 
soon  dubbed  him  "the  crook."  On  several  occasions  he 
took  money  from  desks,  and  when  the  other  boys  heard 
of  this,  though  they  were  in  no  wise  angels  themselves, 
they  shunned  him  more  than  ever.  Against  this  he  rebelled 
and  played  truant  one  afternoon,  but  came  back  the  next 
day  pleading  for  mercy.  At  times  he  did  very  well  in  his 
studies,  but  for  the  most  part  his  work  was  unsatisfactory. 

In  the  fall  of  that  year  his  mother  reported  that  he  had 
entered  a  parochial  school  and  was  doing  well;  but  he 
had  acquired  the  fever  for  work  and  wanted  to  leave 
school  as  soon  as  he  was  fourteen  years  old. 

During  Christmas  week  of  1910  he  worked  at  a  depart- 
ment store  and  did  well.  During  the  latter  part  of  Janu- 
ary, 1911,  he  secured  a  position  in  a  drug  store  where  he 
received  three  dollars  per  week  for  running  errands.  At 
last  account  he  was  continuing  faithful  in  his  duties  and 
had  shown  no  signs  of  dishonesty,  though  surrounded  with 
temptations. 

The  most  notable  case  and  one  attracting  wide  attention 
was  I.  J.,  Case  45,  brought  by  the  Visiting  Nurse  Society 
on  account  of  general  retardation.  When  first 
brought  to  the  clinic  in  the  summer  of  1909 
she  was  five  years  and  two  months  old,  though  her  height 
and  weight  were  those  of  a  child  of  three  years.  She  was 
not  able  to  speak  a  word,  but  would  prattle  like  a  baby 
of  twelve  months.  She  was  taking  her  first  steps  from 
one  piece  of  furniture  to  another.  She  walked  with  her 
feet  far  apart  and  hands  extended,  ready  to  grasp  the  next 
support.     She  smiled  occasionally,  but  usually  kept  her 


SOCIOLOGICAL  RELATIONS  321 

mouth  tightly  closed,  grinding  hor  tooth  all  the  time. 
When  pleased  she  would  utter  queer  little  grunting  and 
squealing  noises.  She  smiled  normally  when  tickled,  but 
did  not  laugh.  When  first  given  a  doll  some  time  before,  she 
tore  its  clothes  off  and  whirled  it  around  by  the  toes.  She 
was  just  beginning  to  play  with  clothespins  and  other  toys. 

Her  special  senses  were  apparently  normal .  She  listened 
to  the  ticking  of  the  watch,  but  attempted  like  a  baby  to 
put  it  into  her  mouth  and  clutch  at  the  hands,  showing 
great  surprise  because  she  could  not  reach  them  through 
the  crystal.  She  would  play  with  colored  blocks  by  throw- 
ing them  down  on  the  table  and  scattering  them  about. 

Her  general  appearance  was  most  pleasing.  She  was  a 
mulatto  with  pale  olive  skin,  black  eyes,  long  lashes,  and 
delicate,  well-formed  nose  and  mouth. 

Her  countenance  wore  an  expression  of  infantile  gravity 
and  suppressed  humor  which  made  her  an  altogether 
charming  little  child.  She  was  reported  as  being  generally 
good  tempered,  but  when  angry  would  fight,  scratch,  and 
bite.  She  ate  only  liquid  food  and  would  cry  if  something 
solid  found  its  way  into  her  mouth.  There  were  no 
stigmata  present. 

The  mental  examination  gave  her  the  intellectual  status 
of  a  child  about  one  year  old;  indeed,  one  test  indicated 
that  the  infantile  instinct  of  grasping  when  the  palms 
were  touched  was  still  present.  When  the  examiner 
placed  his  forefinger  in  the  palms  of  her  hands  her  fingers 
involuntarily  closed  over  them  and  she  had  not  suflScient 
coordination  to  release  his  fingers  when  her  arms  were 
drawn  above  her  head,  through  she  desired  at  the  same 
time  to  play  with  some  blocks  before  her.  Her  disappro- 
bation of  this  involuntary  captivity  was  expressed  by  her 
usual  squeaky,  grunting  sounds. 
21 


322     THE  CONSERVATION  OF  THE  CHILD 

Her  subsequent  two  years'  history  is  interesting.  As  her 
backwardness  appeared  to  be  due  to  malnutrition,  she 
was  sent  for  six  weeks  to  a  seashore  sanitarium,  conducted 
under  the  auspices  of  a  daily  newspaper.  In  the  short 
time  of  a  month  and  a  half  marvels  were  wrought  in  her 
development  and  physical  appearance.  She  gained  flesh 
rapidly  and  took  on  the  appearance  of  a  plump,  well-fed 
child.  She  learned  to  walk  fairly  well  and  to  talk  by  using 
short  sentences. 

Later  she  was  placed  in  the  training  school  at  Vineland, 
N.  J.,  for  a  long  period  of  medical  treatment  and  observa- 
tion under  special  training  to  determine  her  exact  mental 
status,  and  her  future  proper  place  in  society. 

The  social  ramifications  of  the  work  are  indicated  as  much 
hy  the  disposal  of  the  children  as  by  the  sources  from  which 
they  are  received.  In  general,  the  cases  may  be  classified 
roughly  according  to  their  disposal  into  three  groups. 
Some  are  cured  immediately  by  medical  or  surgical  means 
and  need  no  further  special  training  in  order  to  regain 
their  normal  places  in  society  or  at  school.  Another  group 
includes  those  who  are  reheved  by  medical  or  surgical 
treatment  but  require  training  in  some  kind  of  a  special 
class  or  institution  before  they  can  take  their  normal 
places  in  school  and  society.  Still  a  third  class  is  made 
up  of  those  who  are  incurably  retarded  and  would  become 
candidates  for  permanent  incarceration  if  there  were 
enough  institutions  to  hold  them. 

The  Immediately  Curable  Cases. — The  first  class, 
those  who  are  cured  by  medical  or  surgical  relief,  are  the 
ones  for  whom  the  clinic  performs  probably  the  greatest 
service  with  the  least  expenditure  of  time  and  energy. 
Usually  they  are  children  so  near  normal  that  their  guard- 
ians or  parents  would  not  think  of  taking  them  to  a  physi- 


SOCIOLOGICAL  RELATIONS  323 

cian  or  modical  clinic.  Such  children  arc  not  considered 
to  be  ill.  Their  physical  defects,  though  highly  important 
as  sources  of  nervous  irritation  and  inability  to  give 
attention,  are,  from  a  pathological  point  of  view,  not  con- 
sidered very  serious.  These  defects  are  supposed  to  be 
"natural"  to  childhood. 

It  is  the  teacher  at  school  who  more  than  anyone  else 
notes  the  cumulative  effects  of  many  slight  ills  or  the 
retardant  result  of  a  grave  one,  though  she  herself  may 
not  recognize  what  they  are.  Finally  she  urges  the  parents 
to  take  the  child  to  the  Psychological  Clinic  for  examina- 
tion. There  the  cause  is  found,  and  through  the  aid  of 
the  social  worker  the  child  reaches  the  proper  medical  or 
surgical  clinics,  and  speedy  relief  follows,  to  the  great 
satisfaction  of  both  parents  and  the  teacher.  F'rom  the 
many  cases  of  this  kind  upon  our  records,  several  typical 
ones  are  here  chosen  in  order  to  illustrate  what  was  done. 

Case  55  is  a  boy  nine  years  of  age  who  was  brought  to 
the  clinic  in  October,  1909,  by  his  mother  on  account  of 
backwardness  in  school  work.  He  was  only  in  the  second 
grade,  though  he  had  been  going  to  school  three  years. 

Nothing  appeared  in  the  boy's  personal  history  to 
account  for  the  retardation.  He  had  had  the  measles  and 
also  the  whooping-cough.  He  had  been  slow  in  immediately 
walking,  but  talked  at  the  normal  time.     His  ^""^^^ 

birth  was  natural.  A  short  time  before  coming  to  the 
clinic  he  had  been  operated  upon  at  the  University 
Hospital  for  adenoids,  and  had  improved  a  little  after 
their  removal. 

The  teacher  reported  that  he  needed  individual  atten- 
tion, but  there  was  no  time  in  school  to  give  it  to  him,  and 
added  the  usual  pedagogical  formula  that  he  was  not  inter- 
ested in  school  work  and  that  most  of  his  errors  were  due 


324     THE  CONSERVATION  OF  THE  CHILD 

to  carelessness.  Possibly  there  was  some  connection 
between  the  boy's  lack  of  interest  and  the  fact  that  he 
arose  at  five  in  the  morning  to  serve  papers. 

The  boy  presented  a  well-nourished  appearance  and  a 
muscular  development  rather  good  for  nine  years,  though 
he  was  short  for  his  age.  Adenoid  signs  appeared  in  a 
nose  broad  and  flattened  at  the  base,  with  small  nostrils, 
and  in  a  high  and  narrow  palate. 

He  could  read  in  the  second  reader,  but  did  not  seem 
to  be  able  to  remember  what  he  had  read.  He  could  not 
subtract  18  from  25,  nor  could  he  divide  50  by  25,  nor 
subtract  25  from  50.  His  special  ability  was  spelling  and 
in  this  study  he  usually  made  a  grade  of  80  per  cent,  or 
90  per  cent. 

His  eyes  were  examined  and  glasses  fitted  for  overcoming 
the  defect  discovered.  Since  that  event,  every  report  from 
his  mother  stated  that  he  was  doing  very  well,  exceptingthat 
he  had  lost  two  pairs  of  glasses  and  had  broken  a  third  pair. 

On  October  10,  1910,  his  eyes  were  again  refracted,  and 
when  asked  by  the  doctor  why  he  did  not  study  and  make 
up  his  mind  to  learn  carpentry,  he  replied  that  there  was 
no  use  doing  anything  because  the  world  was  coming  to  an 
end  before  he  grew  up,  so  it  would  only  be  a  waste  of  time 
to  learn  anything. 

In  February,  1911,  his  mother  reported  that  he  was 
doing  very  nicely  in  the  public  school  in  all  his  studies, 
and  that  he  had  brought  his  grades  in  history  up  to  94 
per  cent,  and  in  geography  up  to  85  per  cent. 

This  boy  is  illustrative  of  many  who  are  backward 
because  of  some  physical  defect  which  is  discoverable 
through  a  careful  examination,  and  which  when  removed 
permits  the  child  to  respond  rapidly  to  the  ordinary 
modes  of  teaching. 


SOCIOLOGICAL  RELATIONS  325 

Case  300  is  a  girl  four  and  one-lialf  years  old  who  was 
brought  by  her  mother  from  a  distant  city  on  account  of 
backwardness.  Her  birth  was  instrumental  but  n(jt 
difficult.  Though  she  nursed  naturally  the  milk  did  not 
agree  with  her  and  she  became  very  much  emaciated.  On 
account  of  a  threatened  attack  of  cholera  infantum,  arti- 
ficial feeding  was  substituted,  and  she  was  taken  to  the 
country  when  seven  weeks  old,  weighing  at  that  time  only 
seven  pounds.  From  the  age  of  seven  weeks  she  began 
to  grow  and  thrive.  Later  she  contracted  whooping-cough, 
but  from  that  time  on  was  never  seriously  ill.  Her  first 
tooth  came  at  six  months  and  she  began  to  walk  when 
about  two  years  old. 

Eight  months  before  her  birth  her  father  died  suddenly 
of  heart  disease  at  the  age  of  thirty-nine.  The  mother 
naturally  suffered  intensely  from  the  shock  of  Restored  by 
her  husband's  death  and  from  the  additional  Training 
worry  over  the  fact  that  her  own  mother  was  going  blind. 

At  times  the  child's  eyes  would  become  badly  crossed 
and  refused  to  converge  properly,  though  they  seemed  to 
converge  well  enough  at  other  times.  Defective  vision 
was  indicated  by  her  general  demeanor,  and  by  the  fact 
that  she  very  seldom  looked  at  any  object  or  person.  She 
could  not  talk,  but  could  make  a  few  grunting  noises.  Her 
tonsils  were  very  much  enlarged. 

It  was  recommended  that  she  be  taken  to  a  hospital 
for  examination  of  the  nose,  throat,  and  eyes.  This  was 
done — her  eyes  were  examined  and  treated  and  she  was 
fitted  with  the  proper  glasses.  Later  she  underwent  an 
operation  for  the  removal  of  adenoids  and  enlarged  tonsils, 
and  three  days  later  she  had  so  improved  that  she  was 
sent  back  home.  Two  months  after  the  operation  the 
mother  reported  a  wonderful  improvement,  stating  that 


326     THE  CONSERVATION  OF  THE  CHH.D 

the  child  was  happy  again  and  very  much  interested  in 
things  she  never  noticed  before,  Uke  rain,  snow,  clouds, 
pictures,  etc.  She  seemed  to  understand  everything  that 
was  said  to  her,  and  her  efforts  at  speaking  were  noticeable 
in  her  more  frequent  attempts  to  make  sounds.  Owing 
to  the  distance  of  her  home  from  Philadelphia,  it  was  not 
possible  for  the  clinic  to  give  her  speech  training,  which 
no  doubt  would  have  greatly  aided  her  in  the  acquisition 
of  language. 

E.  C,  Case  148,  is  a  girl  nine  years  of  age,  brought  to 
the  clinic  in  February,  1910,  because  of  slowness  in 
learning  at  school.  She  had  started  at  school  when  seven 
years  of  age  after  being  taught  at  home.  Had  been  entered 
in  the  second  grade,  and  at  the  age  of  nine  was  in  the  third 
grade.  Her  backwardness  was  not  exceedingly  marked, 
but  had  been  increasing,  and  consequently  it  gave  her 
parents  some  uneasiness. 

No  abnormalities  appeared  in  the  family  history  as  far 
as  it  was  procured.  During  her  own  lifetime  the  girl 
Cured  by  Suffered  from  a  number  of  acute  diseases,  among 
Glasses  them  a  very  bad  case  of  eczema  of  the  entire 
body,  from  head  to  foot.  She  had  had  congestion  of  the 
brain  when  she  was  only  five  years  old,  and  again  when 
she  was  eight.  In  the  preceding  July,  before  coming  to 
the  clinic,  she  had  an  extremely  sore  throat,  which  was 
reported  to  be  diphtheritic.  She  also  complained  of  suffer- 
ing a  great  deal  from  headache.  No  marked  stigmata 
were  apparent.  Her  nose  and  open  mouth  indicated 
adenoids  and  probably  enlarged  tonsils. 

She  was  recommended  to  a  nose  and  throat  clinic  and 
to  an  eye  clinic,  where  hypertrophied  adenoids  and  tonsils 
were  diagnosed  and  the  eye  examination  revealed  a 
marked  defect  in  vision.  She  was  operated  upon  and  glasses 


SOCIOLOGICAL  RELATIONS  327 

were  fitted.  February,  1911,  about  one  year  afterward, 
a  letter  was  received  at  the  clinic  from  the  child's  mother 
reporting  a  decided  change  for  the  better  in  her  abihty  to 
learn  at  school  and  in  music.  At  the  present  time  her 
eyes  have  improved  so  much  from  the  medical  treatment 
that  she  has  been  able  to  lay  aside  the  spectacles.  She 
makes  good  progress  in  her  school  work  and  is  able  to 
succeed  easily  with  lessons  which  formerly  she  could  not 
learn.  In  music  she  has  been  able  to  surpass  her  own 
mother  in  ability,  and  at  the  date  of  the  report  was  en- 
gaged to  give  public  performances.  She  is  reported  as 
being  different  in  every  way. 

This  case  illustrates  the  class  of  children  who  recover 
immediately  upon  the  removal  of  physical  defects  which 
had  caused  the  temporary  retardation. 

The  Rapidly  Curable  Cases. — IVIany  cases,  however, 
are  not  so  readily  restored  to  normality  as  the  ones  just 
noted.  Many  of  them  require  special  training  and  for 
two  reasons.  First,  as  has  been  intimated  in  preceding 
chapters,  some  cases  cannot  be  immediately  classified  and 
require  special  pedagogical  observation  before  it  can 
finally  be  decided  whether  their  mental  retardation  is 
curable  or  not.  Secondly,  some  cases  which  are  classified 
as  temporarily  retarded,  after  the  removal  of  their  physical 
defects,  require  intensive  pedagogical  methods  in  order  to 
recover  the  lost  ground  and  again  reach  their  normal  place 
in  school  and  society. 

The  Hospital  School. — The  needs  of  the  former  class, 
those  requiring  temporary  observation  in  order  to  make 
a  proper  classification,  have  made  necessary  an  institution 
so  closelj^  related  to  the  Psychological  Clinic  that  it  can 
truly  be  said  to  be  a  part  of  it.  This  may  be  variously 
styled  a  school  of  observation,  an  observing  ward  or  a 


328     THE  CONSERVATION  OF  THE  CHILD 

hospital  school.  It  should  partake  of  the  functions  of  a 
home,  a  school  and  a  hospital.  To  it  should  be  sent  those 
children  who,  b}^  reason  of  their  wavering  mental  powers, 
seem  to  linger  on  the  borderland  between  true  amentia 
and  normality.  Usually  they  suffer  from  a  number  of 
physical  defects  of  such  a  nature  that  the  defects  may  cause 
their  retardation.  The  diagnosis  is  therefore  extremely 
difficult  and  requires  a  long  time  to  be  made  with  certainty. 
These  children  should  be  freed  from  physical  defects  by 
surgical  and  medical  treatment;  they  should  then  be 
taught  and  closely  observed  in  a  model  school  and  cared 
for  in  an  ideal  home.  After  a  time  of  such  treatment  their 
cases  can  be  diagnosed  with  certaintj^  and  they  can  be 
sent  to  their  proper  places  in  societj^  or  in  institutions  for 
their  permanent  welfare. 

The  relation  of  the  clinic  to  a  hospital  school,  as  well 
as  the  reasons  for  the  establishment  of  the  latter,  are  thus 
made  clear.  One  supplements  and  aids  the  other.  While 
the  chief  functions  of  the  clinic  are  classifications  and  the 
dissemination  of  advice  as  to  the  suitable  pedagogical 
methods  for  training  special  children,  in  many  cases  neither 
the  classification  itself  nor  the  subsequent  training  can  be 
carried  on  to  satisfactory  completion  without  a  place  where 
the  child  can  be  observed  and  cared  for  under  the  closest 
daily  scrutiny.  Those  conditions  demand  a  hospital  school 
just  as  a  medical  dispensary  demands  a  hospital  ward. 

It  might  be  thought  by  those  unacquainted  with  the 
true  circumstances  that  hospitals  and  schools  enough  are 
NeedofHos-  already  provided  by  the  appropriations  of  legis- 
pitai  School  lature  or  the  munificence  of  private  purses.  It 
should  be  remembered  first  that  a  hospital  school,  such 
as  is  here  contemplated,  is  not  a  permanent  home  or 
school.     Theoretically,  it  is  merely  a  temporary  abiding 


SOCIOLOGICAL  RELATIONS  329 

place  for  the  child  until  the  classification  is  completed. 
That,  at  least,  is  what  it  would  be  under  ideal  directions. 
But  under  the  conditions  now  prevailing  practically 
everywhere  in  the  country,  such  a  temporary  shelter  is 
made  necessary  by  the  wofully  inadequate  provision, 
either  by  public  or  private  charity,  for  the  feeble-minded. 
As  already  indicated,  the  lowest  conservative  estimate 
places  their  number  in  America  at  150,000;  th6  highest  at 
about  double  that  number.  Of  these  only  18,000  are  pro- 
vided for  in  public  and  private  institutions  and  17,000 
more  are  in  public  schools,  where  they  arc  received  per- 
force or  by  the  grace  of  the  school  officials  until  the  dawn- 
ing of  a  public  conscience,  in  a  more  enlightened  day,  will 
demand  their  proper  care  and  training  in  suitable  colonies. 
The  other  hundred  or  hundred  and  fifty  thousand  are  not 
systematically  cared  for,  but  must  depend  upon  the  happy 
accident  of  birth  or  fortunate  circumstances  of  chance  to 
secure  any  attention  appropriate  to  their  needy  condition. 
All  too  certain  it  is  that  many  of  them,  by  force  of  circum- 
stances or  the  W'ill  of  others,  suffer  worse  neglect  or  harsher 
treatment  than  that  accorded  to  their  normal  brothers  of 
the  same  social  position.  To  all  of  these  neglected  children 
it  is  possible  for  hospital  schools  to  minister,  or,  at  least, 
to  open  a  door  of  hope. 

Some  Rapidly  Curable  Cases.— Those  children  who 
are  not  immediately  restored  by  the  removal  of  physical 
defects,  but  require  certain  kinds  of  pedagogical  training 
before  their  complete  restoration,  bring  the  clinic  in  touch 
with  its  widest  range  of  associations.  The  training  is 
given  in  many  places  and  in  a  variety  of  classes  and  schools. 
Out  of  a  large  number  several  cases  have  been  selected  in 
order  to  illustrate  the  care  of  these  particular  children. 

Case  319  was  a  boy  three  j^ears  of  age,  who  was  referred 


330     THE  CONSERVATION  OF  THE  CHILD 

to  the  clinic  by  the  Children's  Bureau  on  October  29, 
1910,  because  of  his  inability  to  speak.  He  had  been  very 
backward  from  birth  and  very  troublesome  in  the  house, 
where  he  occasioned  his  nervous  mother  great  annoyance. 
She  was  in  the  habit  of  leaving  him  and  his  brother  alone 
while  she  went  out  to  work. 

Upon  examination  he  seemed  to  be  a  bright  and  intelli- 
gent child.  He  could  understand  language,  would  say  a 
Speech  ^6W  words,  "papa,"  "mama,"  "dada,"  and 
^^^  seemed  to  make  an  effort  to  say    "horse."    He 

learned  quickly  how  to  blow,  but  refused  to  place  the  lips 
in  position  for  the  "p"  sound.  The  word  "mama"  was 
very  high  and  unnatural,  but  "dada"  was  pronounced  in 
a  much  more  natural  tone.  In  trying  to  say  "boy,"  he 
said  "bo."  He  was  recommended  to  attend  the  speech 
class  of  the  clinic  conducted  on  Friday  afternoons,  and 
was  placed  in  one  of  the  boarding  homes  connected  with 
the  clinic. 

He  was  again  examined  on  November  11,  1910.  He 
gave  the  "t"  and  "o"  sounds  upon  command.  He  made 
two  attempts  to  combine  "t"  and  "o,"  but  did  not  suc- 
ceed. On  November  14  a  report  was  received  from  the 
caretaker  with  whom  the  child  was  staying  that  he  is  con- 
stantly chattering  and  making  every  effort  to  talk. 

Still  a  third  class  remains  to  be  dealt  with.  It  includes 
all  those  children  who  are  mentally  defective  and  require 
life-long  care  in  some  institution  for  their  best  training 
and  treatment.  Theoretically,  all  the  children  so  diag- 
nosed at  the  clinic  should  be  sent  to  institutions  and 
usually  applications  are  made  for  entrance  to  such  schools. 
However,  under  the  conditions  usually  existing  it  is  fre- 
quently impossible  to  secure  entrance  for  those  unable  to 
pay  for  their  care  and  training.     Therefore,  it  happens 


SOCIOLOGICAL  RELATIONS  331 

that  some  of  these  children  are  sent  back  to  their  o\\'n 
homes  and  their  parents  given  instructions  for  their  best 
possible  training  under  the  circumstances.  Often,  as  is 
the  case  given  below,  such  a  course  is  satisfactory.  In 
the  majority  of  cases,  however,  attempts  are  made  to 
secure  entrance  in  some  proper  institution  for  life-long 
segregation  of  these  children  from  the  mass  of  society. 
At  still  other  times  it  is  possible  to  make  arrangements 
with  some  other  organization  where  the  proper  training 
may  be  given  the  feeble-minded  child,  and  at  the  same 
time  he  may  live  at  home. 

Case  46  was  a  girl  thirteen  years  of  age  who  was  brought 
to  the  clinic  in  August,  1909,  on  account  of  general 
retardation,  by  her  father,  the  principal  of  a  boarding 
school  for  5'oung  ladies.  He  stated  that  she  could  do 
nothing  with  figures,  could  not  even  tell  which  was  the 
greater  of  any  two  numbers.  She  went  to  the  public 
schools  for  a  short  time  before  the  family  moved,  but 
most  of  her  life  she  had  been  under  the  care  of  teachers 
of  the  boarding  school. 

When  about  twelve  years  of  age  she  had  pneumonia. 
She  had  had  none  of  the  ordinary  children's  diseases 
except  whooping-cough.     She  was  a  blue  baby 
born  with  instruments,  and  her  head  was  very  Home 

misshapen.      She    walked   when   about    fifteen 
months  and  talked  a  little  earlier  than  that.    Her  brother, 
who  is  eleven  years  old,  is  as  conspicuous  for  his  brightness 
and  reasoning  powers  as  she  is  for  her  dulness. 

At  the  time  of  the  examination  she  was  a  well-nourished 
and  healthy  girl,  rather  stout  and  tall  for  her  age.  She  had 
a  good  appetite  and  slept  well,  going  to  bod  at  9.30  in  the 
evening,  and  not  rising  until  8.00  o'clock  in  the  morning. 
She  stated  that  her  eyes  hurt  her  when  she  read  too  much. 


332     THE  CONSERVATION  OF  THE  CHILD 

She  had  normal  hearing,  the  right  ear  apparently  being 
a  little  better  than  the  left.  Her  skull  was  brachy cephalic 
with  no  especial  protuberances. 

The  mental  examination  showed  her  to  be  fair  at  spell- 
ing and  reading  in  the  sixth-grade  book,  and  she  had  an 
intelligent  idea  of  what  she  read.  She  spelled  "horse," 
"azure,"  "marriage"  correctly,  but  gave  up  trying  to 
spell  "original,"  "magnificent."  She  said  that  she  could 
not  spell  "Waterloo"  or  "German."  She  did  not  know 
all  of  the  multiplication  tables  She  said,  for  example, 
three  times  three  equals  nine;  four  times  four  equals  eight; 
three  plus  two  equals  five,  and  twenty-three  plus  nine 
she  could  not  answer.  She  matched  four  colors  accurately 
from  memory,  but  it  was  easy  to  make  her  uncertain 
whether  she  was  right  or  not.  She  failed  in  matching 
five  colors  at  one  time.  She  was  not  good  at  relating 
incidents,  though  she  caught  impressions  and  remembered 
isolated  things  very  well,  but  did  not  grasp  relations, 
either  in  reading  matter  or  in  telling  about  something 
which  had  happened.  She  remembered  unusual  things 
which  people  are  not  apt  to  notice.  She  was  very  fond  of 
music  and  seemed  to  have  talent,  played  the  piano  by 
note  or  by  ear;  but  progress  in  music  had  not  been  very 
good  because  she  would  not  apply  herself. 

She  was  very  affectionate,  and  liked  to  play  with  smaller 
children,  from  six  to  ten  years  old;  she  was  also  particu- 
larly fond  of  babies.  She  would  go  with  girls  of  thirteen 
years  for  anything  like  sight-seeing,  but  would  not  join 
them  in  games  that  required  any  real  application.  She 
had  an  aversion  to  work  of  any  sort,  and  had  not  been 
trained  to  make  beds  and  help  around  the  house.  If  left 
to  herself  she  would  spend  the  day  romping  with  children 
half  her  age  or  petting  the  cows.     She  was  very  fond  of 


SOCIOLOGICAL  RELATIONS  333 

commendation,  and  for  this  reason  would  rather  help 
other  people  than  her  mother.  She  could  dress  herself, 
but  she  could  not  comb  her  own  hair.  She  had  a  bad 
temper,  and  when  crossefl  became  very  sulky. 

Her  father  was  informed  that  this  daughter  was  feeble- 
minded and  would  never  make  progress  at  an  ordinary 
school,  nor  be  able  to  take  full  charge  of  her  own  affairs 
in  life.  He  was  advised  concerning  the  kind  of  education 
she  might  acquire  and  the  methods  to  be  pursued  in  her 
training.  His  intelligence  and  pedagogical  skill  made  it 
possible  for  him  to  give  her  instruction  at  home,  where  she 
is  at  present. 

Case  29  was  a  boy  eight  years  of  age  brought  to  the 
clinic  by  his  mother  on  July  20,  1909,  on  account  of  back- 
wardness in  school  occasioned  both  by  defective  speech 
and  bad  conduct.  At  six  years  of  age  he  entered  a  paro- 
chial school  and  was  still  in  the  first  grade  at  eight  years. 
;The  teacher  in  whose  class  he  was  considered  him  a 
"dumb  child." 

Added  to  the  usual  children's  diseases,  including  measles, 
mumps,  and  whooping-cough,  he  also  had  an  attack  of  con- 
vulsions at  about  one  year  of  age,  lasting  from  a 
quarter  to  eight  o'clock  Sunday  night  until  Helped  byl 
quarter  to  eleven  Monday  morning,  which  left  ^^"^^  *" 
him  unconscious  until  Wednesday.  The  attack  appeared  to 
come  from  a  temporary  cause, — eating  too  much  cake  wth 
currants  in  it, — as  the  spasms  did  not  return  and,  so  far  as 
the  mother  knows,  they  left  no  permanent  bad  effect.  He 
began  walking  at  eighteen  months  and  talked  about  the 
same  time.  His  tonsils  had  been  removed  about  three 
years  before  coming  to  the  clinic.  On  making  the  exami- 
nation of  the  child  at  the  hospital,  the  physicians  said 
that  he  was  tongue-tied,  and  that  they  would  operate  for 


334     THE  CONSERVATION  OF  THE  CHILD 

it  while  he  was  under  ether,  but  the  mother  could  see  no 
difference  in  his  ability  to  talk  after  the  operation.  No 
causes  for  the  speech  defect  appeared  either  in  his  vocal 
organs  or  in  the  circumstances  of  his  birth,  which  was 
natural  but  prolonged  almost  to  the  point  of  asphyxiation. 
As  far  as  it  could  be  ascertained,  the  family  history  on 
both  sides  of  the  house  was  normal. 

The  physical  examination  showed  that  he  was  subject 
to  attacks  of  indigestion  accompanied  with  headache,  and 
that  he  breathed  with  his  mouth  open.  An  examination 
of  the  throat  showed  large  quantities  of  mucus  dropping 
down  from  the  posterior  nares.  A  careful  diet  was  recom- 
mended and  a  spray  was  prescribed  by  a  physician  for 
the  nasal  condition. 

The  mental  examination  proved  him  to  be  completely 
muddled  on  the  subject  of  the  alphabet,  although  he  had 
been  specially  drilled  on  it  by  his  mother  even  before  he 
commenced  school.  He  could  count  to  twelve,  but  could 
do  nothing  with  simple  arithmetical  problems.  His 
spelling  was  equally  poor.  The  mother  reported  that  she 
had  notes  from  his  teacher,  stating  that  each  day  he  became 
less  able  to  do  his  lessons  and  was  so  troublesome  that  he 
disturbed  the  order  of  the  whole  room.  The  principal  of 
the  school  reported  that  he  was  absolutely  impossible  as  a 
pupil  and  that  no  one  could  teach  him  anything.  This 
report  was  in  harmony  with  the  mental  diagnosis  which 
indicated  that  the  boy  was  a  middle-grade  imbecile. 

It  was  recommended  that  he  be  placed  in  a  school  for 
the  feeble-minded,  but  his  father  objected  to  sending  him 
there,  and  insisted  that  a  great  deal  of  the  child's  back- 
wardness came  from  shyness.  At  home  it  was  surprising 
to  see  how  well  he  was  able  to  spell,  and  pronounce  words 
when  his  father  taught  him.    In  his  opinion  the  boy  was 


SOCIOLOGICAL  RELATIONS  335 

so  shy  that  it  would  take  months  for  him  to  maicf'  friends 
with  new  teachers. 

Finally  he  was  removed  from  the  school  he  was  attend- 
ing and  entered  in  a  special  class  near  the  homo  of  his 
aunt  with  whom  he  went  to  live,  and  who  gave  him  her 
special  attention.  With  her  training,  and  that  received  at 
the  special  class,  the  ])oy  made  fair  progress  for  one  in 
his  mental  condition,  and  when  last  heard  from  in  Jan- 
uary, 1910,  he  was  described  by  his  mother  in  terms  of 
ample  praise  and  reported  by  his  teacher  "as  getting  along 
all  right."  This  should  not  be  taken  to  mean  that  the 
boy  is  normal  mentally,  nor  that  he  learns  like  other  chil- 
dren, but  only  to  illustrate  what  is  here  intended,  namely, 
that  many  children  can  be  helped  by  special  training 
different  from  the  regular  school  teaching. 

Case  238,  a  girl  of  sixteen,  was  brought  to  the  clinic 
by  her  mother  and  a  probation  officer  because  of  moral 
delinquency.  She  first  began  school  when  six  years  of  age 
and  though  not  beyond  the  third  grade  left  when  she  was 
fourteen.  Her  school  career  was  further  shortened  by 
persistent  truancy.  After  leaving  school  her  irregular 
conduct  manifested  itself  in  her  inability  to  hold  a  posi- 
tion for  any  length  of  time. 

In  her  family  there  had  been  eleven  children,  only 
three  of  whom  are  living.  The  youngest  living  child,  then 
eleven  years  old,  was  in  the  second  grade  because  ^  yi^^^i 
he  did  not  begin  school  until  he  was  eight  on  imbecile 
account  of  general  poor  health  and  some  skin  trouble. 
One  child  had  succumbed  to  tuberculosis;  and  the  others 
died  in  infancy,  two  of  them  very  suddenly  when  only 
one  day  old  from  unknown  causes,  and  another  a  little 
older  from  convulsions.  In  addition  there  had  been  one 
miscarriage  and  one  still-birth.      The  mother  was  living 


336     THE  CONSERVATION  OF  THE  CHILD 

and  had  kidney  trouble,  and  reported  to  have  been  at  one 
time  "stone  bhnd."    The  father  died  from  consumption. 

The  bad  family  history  was  perpetuated  in  the  girl's 
physical  condition.  She  suffered  from  a  variety  of  defects 
and  stigmata.  Her  vision  was  defective;  the  notchings  of 
her  teeth  indicated  some  specific  inherited  disease  or  early 
rachitis.  Adenoid  growths  were  present  in  the  post-natal 
passages.  Her  nutrition  was  poor  and  her  general  appear- 
ance denoted  mental  enfeeblement. 

The  mother  stated  that  since  the  time  of  the  girl's 
second  dentition  she  had  suffered  from  ungovernable  rage, 
was  always  disobedient,  and  used  vile  language  continu- 
ally. She  had  always  been  very  untruthful  and  denied 
her  misdeeds  point  blank  even  when  caught  in  the  act  of 
committing  them.  She  was  lazy  and  very  loath  to  rise  in 
the  mornings,  but  quite  as  unwilling  to  go  to  bed  at  a 
seasonable  hour.  She  was  so  uncleanly  in  her  personal 
habits  that  she  was  discharged  from  her  last  position  for 
this  reason. 

Her  case  was  diagnosed  as  mental  and  moral  imbecility, 
and  the  probation  officer,  who  had  charge  of  her,  was 
advised  of  her  moral  irresponsibility.  The  girl  was  accord- 
ingly committed  to  the  observation  ward  of  a  hospital  in 
June,  1910.  Later  she  became  entirely  insane  and  is  at 
present  in  an  asylum  where  her  congenital  immoral 
tendencies  can  do  no  harm  to  others. 

Case  20  was  a  boy  fifteen  years  of  age  who  was  brought 
to  the  clinic  in  July,  1909,  by  his  father  because  of  back- 
wardness in  school.  He  had  been  attending  school  for 
nine  years,  excepting  one  year  when  he  had  a  very  bad 
case  of  diphtheria,  and  had  covered  only  three  grades. 

Besides  having  diphtheria,  he  had  mumps,  whooping- 
cough,  measles  and  chicken-pox.    When  about  ten  years 


SOCIOLOGICAL  RELATIONS  337 

old  he  foil  off  a  twenty-foot  stone  wall  and  alighted  on 
the  top  of  his  head.  It  stunned  him  for  a  while,  but 
left  no  scar  or  other  bad  effects.  When  five  or  six  years 
old  he  fell  from  a  fence  and  struck  his  head,  a  DanKcrous 
but  this  mishap  likewise  appeared  to  leave  no  "^ 

permanent  injury.  When  about  twelve  or  thirteen  years 
old,  while  riding  a  bicycle,  he  ran  into  a  wagon  and  two 
ribs  were  displaced. 

Besides  this  series  of  accidents,  he  suffered  from  rickets 
and  for  a  time  he  was  very  bow-legged.  He  was  passion- 
ately fond  of  eating  lime,  and  even  before  he  was  able  to 
walk  he  would  pull  plaster  off  the  wall  in  the  room  or 
pick  mortar  out  between  bricks  in  the  yard  and  eat  it. 
His  first  steps  were  delayed  until  he  was  about  three  and 
one-half  years  old,  and  he  was  equally  retarded  in  learning 
to  talk.  His  enunciation  was  still  poor  at  the  age  of 
fifteen,  partially  due  to  bad  occlusion  of  his  front  teeth, 
one  of  which  had  been  broken  in  one  of  his  falls.  His 
articulation  was  obviously  further  hampered  by  ade- 
noid gro\\'ths,  the  presence  of  which  was  later  con- 
firmed at  a  medical  examination. 

The  mental  examination  showed  that  he  could  spell 
and  read  fairly  in  a  second-grade  book,  but  that  he  was 
very  poor  in  arithmetic.  He  did  not  know  his  multipli- 
cation table,  though  the  father  had  supplemented  the 
public  school  teacher's  efforts  by  drilling  him  at  night  for 
two  years.  He  said,  for  example,  eight  times  seven  equals 
sixty-three.  His  fondness  for  athletics  impelled  him  to 
read  the  baseball  news  in  the  daily  paper,  but  nothing 
more.  He  spelled  elephant,  e-1-e-p-h-e-n-t,  and  picture, 
p-i-c-h-e-r,  but  could  spell  correctly  catcher,  base  and  fielder. 
He  played  baseball  and  other  games,  and  spent  much  of 
his  indoor  time  making  boxes  and  toys  with  his  father's 
22 


338     THE  CONSERVATION  OF  THE  CHILD 

tools.  He  was  not  clean  or  neat  in  his  personal  habits; 
bolted  his  food,  and  neglected  bathing  and  cleaning  his 
teeth. 

To  his  mental  retardation  was  added  a  violent  temper 
which  often  exhibited  itself  in  ungovernable  outbreaks, 
especially  at  home,  during  which  he  had  several  times 
offered  violence  to  members  of  the  family.  For  this 
cause,  emasculation  had  been  considered  by  a  superin- 
tendent of  an  institution  for  feeble-minded. 

The  mental  diagnosis  confirmed  the  opinion  of  a  special- 
ist given  some  years  before,  pronouncing  the  boy  a  high- 
grade  imbecile.  At  the  specialist's  advice,  the  father  had 
made  some  effort  to  enter  the  boy  in  the  training  school 
for  the  feeble-minded  at  Elwyn,  Pa. 

At  our  recommendation,  the  boy  was  taken  to  a  nose 
and  throat  clinic,  and  about  ten  days  later  he  underwent 
an  operation  for  the  removal  of  his  adenoids.  After  the 
operation  he  showed  a  marked  improvement  in  temper. 
The  father  was  then  advised  to  enter  him  at  a  Y.  M.  C.  A. 
gymnasium  for  a  three  months'  trial  of  physical  training 
under  the  supervision  of  the  clinic. 

Here  he  was  placed  under  the  tuition  of  the  physical 
director,  who  was  also  a  medical  man,  and  one  of  the 
physical  examiners  at  the  clinic,  to  whose  skill  much  of 
the  favorable  results  of  this  case  were  due. 

About  four  months  of  training  there  made  a  marked 
change  in  his  physical  tone  and  mental  attitude.  He 
improved  so  much  socially  that  he  became  a  member  of  a 
new  boys'  club,  and  exhibited  a  surprising  initiative  by 
enlisting  three  other  boys  in  the  membership  of  the  same 
organization.  A  little  later  he  aspired  to  the  leadership 
of  a  group  of  boys,  and  when  told  that  he  needed  more 
experience,  made  a  request  for  a  book  in  which  he  could 


SOCIOLOGICAL  RELATIONS  339 

study  those  things  which  it  would  be  necessary  for  him  to 
know.  He  was  given  the  book  and  he  took  it  home  and 
studied  it  dihgently.  His  three  months'  progress  was  so 
satisfactory  that  his  training  continued  indefinitely  along 
the  same  lines.  His  gymnasium  work  had  so  toned  up 
his  physical  condition,  and  at  the  same  time  so  stimulated 
his  social  ambitions,  that  he  applied  himself  more  diligently 
and  with  more  interest  to  all  his  tasks.  His  fits  of  evil 
temper  at  home  grew  far  more  infrequent,  and  his  habits 
of  study  improved  so  much  that  in  February,  1910,  he 
was  promoted  to  the  next  grade. 

Case  179  was  a  boy  seventeen  years  of  age  who  was 
brought  to  the  clinic,  March,  1910,  by  his  aunt  because 
of  backwardness  in  school.  He  had  entered  the  public 
school  when  about  six  years  of  age  and  had  studied  regu- 
larly, but  at  the  age  of  seventeen  he  was  only  in  the  lower 
fifth  grade,  and  was  having  the  most  difficulty  with  arith- 
metic and  language. 

It  was  reported  that  at  about  one  and  one-half  years  of 
age  he  suffered  from  a  disease  bordering  on  marasmus. 
Otherwise  he  has  never  had  any  serious  illness. 

.  .  .  A  Case 

At  nme,  on  account  of  his  defective  articulation  sent  to  the 
an  examination  of  his  vocal  organs  had  been 
made  and  again  at  the  age  of  fourteen  his  nose  and 
throat  had  been  examined,  but  no  malformations  were 
found.  No  items  of  significance  appeared  either  in  his 
personal  or  family  history. 

The  physical  examination  at  the  clinic  showed  that  he 
had  a  fairly  well-shaped  head  with  no  marked  protuber- 
ances excepting  on  the  forehead  over  each  eye.  His  eye 
indicated  some  foetal  arrest;  his  mouth  was  very  sensitive, 
his  teeth  were  covered  with  tartar,  irregular  and  full  of 
caries,  with  upper  incisors  entirely  decayed,  and  gums 


340     THE  CONSERVATION  OF  THE  CHILD 

receding  before  the  tartar.  His  upper  jaw  and  lip  extended 
out  over  the  lower.  The  aunt  stated  that  the  boy  would 
eat  very  little,  his  diet  consisting  chiefly  of  ice  cream,  jelly, 
bread,  butter,  and  beans,  all  of  which  he  bolted  v/ithout 
chewing.  Naturally  he  suffered  from  bilious  attacks  and 
headaches. 

The  mental  examination  showed  that  he  could  not  spell 
correctly  such  words  as  "middle,"  "interested,"  "litera- 
ture," and  "original."  He  read  in  the  fifth  reader,  but 
hesitated  much  and  made  several  mistakes.  He  was  poor 
in  arithmetic  and  volunteered  the  information  that  the 
previous  month  he  had  received  a  grade  of  40  in  that 
study.  His  bad  school  record  was  offset  by  his  fondness 
for  manual  working,  willingness  to  run  errands  and  to 
deliver  groceries,  though  he  did  not  seem  to  have  any 
aim  or  ambitions  for  the  future.  He  first  said  that 
he  would  like  to  be  an  engineer,  then  changed  it  to 
machinist,  then  a  carpenter,  and  ended  by  saying  "  any- 
thing would  do." 

It  was  recommended  that  he  be  entered  in  the  New 
Jersey  Training  School  at  Vineland,  N.  J.,  where  he  was 
soon  placed.  At  the  last  report  he  was  looking  much 
better,  with  a  good  healthy  color  and  bright  eyes,  and 
happy  in  learning  the  manual  occupations  for  which  he 
was  fitted.  While  his  mentality  will  never  be  raised  to 
normal,  his  mental  and  manual  acquirements  can  be 
increased,  and,  best  of  all,  the  irregular,  unwholesome 
regime  and  vicious  dietary  of  an  over-indulgent  home  have 
been  replaced  by  sane,  simple  feeding,  fresh  air,  and 
exercise. 

Besides  the  sociological  relations  illustrated  by  selected 
cases  in  the  preceding  pages,  there  are  many  others. 
Among  those  deserving  mention  is  the  friendly  cooperation 


SOCIOLOGICAL  RELATIONS  341 

exhibited  by  medical  men  in  tlieir  willingness  to  give  time 
to  the  clinic  itself  as  medical  examiners,  to  receive  and 
examine  cases  at  their  offices  and  to  refer  their  patients  to 
the  clinic  for  mental  diagnosis.  In  the  last  cuseH  Treat- 
respect,  hospitals,  reformatories,  orphan  asy-  "'^  ^^  ^^'"' 
lums,  and  homes  for  children  are  following  the  example 
of  the  physicians.  Boys'  clubs  and  day  nurseries  arc  also 
turning  to  the  clinic  for  aid  and  advice  regarding  their 
difficult  charges,  and  with  its  help  they  succeed  very 
often  in  relieving  children  from  obstructive  physical 
defects  or  deteriorating  environments.  Finally,  the  good 
offices  of  the  Psychological  Clinic  have  become  so  widely 
known  that  it  is  found,  in  a  few  instances,  necessary  to 
extend  its  influence  to  places  and  to  people  too  remote 
and  too  poor  to  bring  their  children  to  Philadelphia. 
Efforts  have  been  made  by  the  clinic  to  give  advice  by 
mail  concerning  pedagogical  training.  This  is  done  by 
first  securing  full  information  from  parents  in  answer  to  a 
questionnaire  concerning  the  condition  of  the  child.  They 
are  then  advised  to  take  the  child  for  a  physical  examina- 
tion to  some  local  physician,  specialist,  or  medical  clinic, 
and  to  make  sure  that  the  child  is  in  the  best  physical 
condition  possible.  When  this  has  been  done  and  immedi- 
ate relief  has  not  followed,  the  Psychological  Clinic  has 
given  advice  by  mail  as  to  pedagogical  training  and  in 
some  cases  the  results  have  been  gratifying. 

In  all  its  social  work  the  clinic  is  guided  by  the  principle 
of  its  function  as  a  clearing  house  for  all  special  children. 
It  receives  all  children  who  come.  As  far  as  possible  it 
endeavors  to  aid  all  (except  those  under  its  immediate 
care  in  the  Hospital  School)  through  social  institutions 
already  existing.  It  aims  to  be  a  helpful  coordinating 
and  correlating  agency  among  all  societies  and  organiza- 


342     THE  CONSERVATION  OF  THE  CHILD 

tions,  aiming  at  the  welfare  of  children.  As  its  work 
becomes  better  known,  its  possibilities  for  good  continually 
broaden  and  the  value  of  its  beneficences  for  the  young 
becomes  increasingly  appreciated  by  all  who  labor  to  make 
each  successive  generation  healthier  and  happier  than  the 
last. 


A   BRIEF  CHRONOLOGICAL   BIBLIOGRAPHY   ON 
MENTALLY  DEFECTIVE  CHILDREN 

Bonaterre,  "Historique  sur  le  Sauvage  de  I'Avcyron,"  ParLs,  1799. 

Itaril,  "De  I'Education  d'  un  Homme  Sauvage,"  Paris,  1801. 

Seguin,  Edward,  "Theorie  et  pratique  de  I'education  dc\s  idiots. 
Lecons  aux  jeunes  idiots  de  I'hospice  des  Incurables,"  premiere 
partie. — Paris,  1842.    Indem,  seconde  partie. — Paris,  184.3. 

S.  G.  Howe,  "Causes  and  Prevention  of  Idiocy,"  Boston,  1848. 

Knight  and  Brockett,  "Reports  of  Commissioners  on  Idiocy  in 
Connecticut,"  Dorchester,  1856. 

KerHn,  Isaac,  "The  Mind  Unveiled,"  Philadelphia,  1858. 

Duncan,  Martin  E.,  "The  Method  Drill  and  Gymnastic  Exercises 
and  the  Manner  of  Teaching  Speaking  Used  at  the  Essex  Ilall, 
Colchester,  for  Idiots,  Simpletons  and  Feeble-minded  Children," 
London, 1861. 

Marce,  L.  V.,  "Traite  Pratique  des  Maladies  Mentales,"  1862. 

Down,  J.  Langdon,  "A  Treatise  on  Idiocy  and  its  Cognate  Affec- 
tions," London,  1867. 

Ireland,  W.  W.,  "On  Idiocy  and  Imbecihty,"  London,  1877. 

KerUn,  I.  N.,  "Juvenile  Insanity,"  Philadelphia,  1879. 

Tuke,  D.  Hack,  "A  Dictionary  of  Psychological  Medicme,"  1892, 
pp.  659,  665,  805. 

Beach,  Fletcher,  M.D.,  "Mentally  Feeble  Children;  Treatment 
and  Education  of,"  London,  1895. 

Bourneville,  Dr.,  "Creation  de  Classes  Speciales  pour  les  Enfants 
Arrieres,"  Paris,  1896. 

Ireland,  W.  W.,  "On  Mental  Affections  of  Children,"  Loudon,  1900. 

Shuttleworth,  G.  E.,  "Mentally  Deficient  Children,"  Second  Edi- 
tion, 1900,  P.  Blakiston  Son  «fe  Co.,  Philadelphia. 

Demoor,  J.,  "Die  Abnormer  Kinder  und  Hire  Erziehhche  Behiind- 
lung  in  Haus  und  Schule,"  Bone,  Altenburg,  1901,  p.  292. 

Sollier,  P.,  "Psychologic  de  L'Idiot  et  de  L'lmbccile  (2nd  Edit.), 
Alcan,  Paris,  1901,  p.  236. 

343 


(:' 


344     THE  CONSERVATION  OF  THE  CHILD 

Weygandt,  W.,  "Die  Behandlung  Idiotscher  und  Imbeciler  Kinder 
im  Aerzlichen  und  Paedogogischer  Beziehung,"  Wurtzburg,  1901, 
p.  103. 

Bourncvillo,  Dr.,  "Recherches  sur  Epilepsie,  I'hysterie  et  I'idiote," 
Alcan,  Paris,  1902,  p.  234. 

Barr,  Martin  W.,  "Mental  Defectives,  Their  History  and  Treat- 
ment,"   Phila.,  1904,  P.  Blakiston  Son  &  Co.,  Philadelphia. 

Binet,  Alfred,  et  Simon,  Theodore,  "Enfants  Anormaux,"  Folin, 
Paris,  1907,  p.  211. 

Seguin,  Edward,  "Idiocy  and  Its  Treatment  by  the  Physiological 
Method,"  Science  Press,  N.  Y.,  1907. 

Royal  Commission,  Report  of,  on  the  Care  and  Control  of  the 
Feeble-minded,  vols,  i-viii,  London,  1908.  Volumes  are  to  be 
had  separately.  Vol.  vii  contains  the  account  of  the  visit  of 
the  Commissioners  to  America.  Vol.  viii  contains  the  conclu- 
sions and  recommendations.     These  are  important. 

Tredgold,  Dr.  A.  F.,  "Mental  Deficiency,"  London,  1908,  p.  391. 
(This  is  the  latest  and  one  of  the  best  works  on  the  subject.) 

JOURNALS. 

American  Breeders'  Magazine,  Washington,  D.  C. 

Bulletin  de  la  Societe  libre  pour  VEtude  psychologique  de  I'enfant, 
Paris,  1911. 

Die  Hilfschule.    Carl  Marhold,  Halle-a.-S. 

Eos.    Published  by  A.  Pichler's  Witwe  und  Sohn,  Wien. 

Eugenics  Review.  Published  by  the  Eugenics  Educational  Society, 
London. 

Journal  of  the  American  Institute  of  Criminal  Law  and  Criminology. 
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Journal  of  Educational  Psychology.  Warwick  &  York,  Inc.,  Balti- 
more, Md. 

Journal  of  Psycho- Asthenics.  Published  by  Minn.  School  for  the 
Feeble-minded,  Faribault,  Minn. 

I'Annee  Psychologique.    Masson  et  Cie,  Paris. 

Pedagogical  Seminary.    Clark  University,  Worcester,  Mass. 

Psychological  Clin  c.    The  Psych.  Clinic  Press,  Philadelphia. 

School  Hygiene.    Dr.  Geo.  S.  Badger,  48  Hereford  St.,  Boston,  Mass. 

The  Training  School.  Published  by  N.  J.  Training  School,  Vineland, 
N.J. 


SOCIOLOGICAL  RELATIONS  345 

Zeitschrifl  fur  die  Erforschung  und  Behandlung  des  Jugendlicfien 

Schivachidnns.    Gustav  Fischer,  Jena. 
Zeilschrift fur  Kindcrforschung .    Beyer  und  Sohne,  LanKcn.salza. 

For  fuller  bibliography  sec  Abnormal  Man  by  Arthur  MaeDonald 
in  Board  of  Education  Circular  of  Informal  ion  No.  4  of  1893. 

Report  of  Commissioner  of  Education,  vol.  ii,  1906,  p.  1290. 

Report  of  Commissioner  of  Education,  vol.  i,  1909,  p.  30. 

Barr,  Martin  W.,  "Mental  Defectives,  Their  History  and  Treat- 
ment,"   P.  Blakiston  Son  &  Co.,  Philadelphia,  1904,  pp.  338-347. 


i 


Lippincott*5  Educational  Series, 

THE  RECITATION 

By  SAMUEL   HAMILTON,  Ph.D. 

Superintendent  of  Public  Schools  of  Allegheny  County,  Pa. 

368  pages.     Cloth,  ^1.25. 

This  volume  is  an  honest  effort  to  aid  young  teachers 
by  simplifying  and  clarifying  for  them  subjects  which  are 
generally  regarded  as  difficult  and  obscure.  The  discussion 
of  the  subject  is  intended  to  be  suggestive  rather  than 
exhaustive.  Throughout  the  book  the  author  has  aimed  to 
be  sound  in  theory,  simple  in  treatment,  clear  and  concise 
in  presentation,  brief  and  pointed  in  discussion,  and  withal, 
practical  and  helpful. 


The  Educational  Process 

By  ARTHUR  GARY  FLESHMAN 
Head  of  the  Dept.  of  Education  and  Psychology  in  the  Mary- 
land State  Normal  School,  Baltimore. 

336  pages.     Cloth,  $1.25. 

The  author  has  had  an  extended  discipline  in  the 
theory  and  the  practice  of  educational  things,  and  presents 
in  this  volume  his  best  thought  as  guidance  for  those  who 
possess  the  hunger  to  know  the  meaning  of  every  act  of 
the  teacher  in  terms  of  purpose  and  in  formula  of  law. 


J.  B.  LIPPINCOTT  COMPANY 

PUBLISHERS  PHILADELPHIA 


Lippincott*s   Educatmial  Series 

Thinking  and  Learning  to  Think 

By  NATHAN  C.  SCHAEFFER,  Ph.D.,  LL.D., 

Superintendent  of  Public  Instruction  of  the  State  of  Pennsylvania, 

351  pages.  Cloth,  I1.25. 
A  series  of  clear  and  practical  lectures  in  the 
difficult  art  of  teaching  pupils  to  think,  designed  to 
throw  light  upon  this  one  important  phase  of  peda- 
gogy, without  in  any  way  pretending  to  supplant  the 
systematic  treatises  on  psychology  and  logic. 

"It  is  a  genuine  pleasure  to  be  able  to  turn  to  a  real  message  of 
helpfulness  and  suggestiveness  from  a  writer  who  has  something  to  say, 
and  says  it  in  a  language  that  a  teacher,  though  a  practical,  sensible  man, 
can  understand.  Such  a  message  is  found  in  '  Thinking  and  Learning 
to  Think.'  " — ITie  Ohio  Educational  Monthly,  Columbus,  Ohio. 

Two  Centuries  of  Pennsylvania 
History 

By  ISAAC  SHARPLESS, 

President  of  Ha-verford  College. 

385  pages.  Illustrated.  Cloth,  $1.25. 
A  history  of  the  Keystone  State,  beginning  with 
the  Pennsylvania  Indians  at  the  time  of  the  white 
settlement  in  the  seventeenth  century,  down  to  the 
present  time,  ending  with  a  summary  of  latter-day 
conditions.  It  is  the  product  of  a  critical  study  by  a 
master  mind  of  the  colonial  and  commonwealth 
epochs  in  the  unfolding  of  a  great  people. 

No  intensive  study  of  pedagogic  maxims  will  afford  the  right  mental 
attitude  for  true  teaching.  There  must  be,  in  additional  to  professional 
study,  a  critical  and  extended  study  of  related  truth.  Only  in  this 
wider  field  does  the  student  of  educational  theory  find  the  necessary 
insight  to  avoid  the  follies  of  charlatanism  and  to  shun  the  evils  of 
bigotry.  The  best  teacher-training  includes  a  broad,  general  culture  as 
well  as  an  extended  pedagogic  training. — Editor's  Preface. 

J.  B.  LIPPINCOTT  COMPANY 

PUBLISHERS  PHILADELPHIA 


UNIVERSITY  OF  CALIFORNIA  LIBRARY 

Los  Angeles 
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